Postdischarge thromboembolic outcomes and mortality of hospitalized patients with COVID-19: the CORE-19 registry

被引：137

作者：

Giannis, Dimitrios ^{[1
,2
]}

Allen, Steven L. ^{[3
,4
]}

Tsang, James ^{[1
]}

Flint, Sarah ^{[1
,4
]}

Pinhasov, Tamir ^{[1
,4
]}

Williams, Stephanie ^{[1
,4
]}

Tan, Gary ^{[1
,4
]}

Thakur, Richa ^{[1
,4
]}

Leung, Christian ^{[1
,4
]}

Snyder, Matthew ^{[1
,4
]}

Bhatia, Chirag ^{[1
,4
]}

Garrett, David ^{[1
,4
]}

Cotte, Christina ^{[1
,4
]}

Isaacs, Shelby ^{[1
,4
]}

Gugerty, Emma ^{[1
,4
]}

Davidson, Anne ^{[5
,6
]}

Marder, Galina S. ^{[5
]}

Schnitzer, Austin ^{[5
]}

Goldberg, Bradley ^{[3
,4
]}

McGinn, Thomas ^{[1
,4
]}

Davidson, Karina W. ^{[1
,4
]}

Barish, Matthew A. ^{[7
]}

Qiu, Michael ^{[1
]}

Zhang, Meng ^{[1
]}

Goldin, Mark ^{[1
,4
]}

Matsagkas, Miltiadis ^{[2
]}

Arnaoutoglou, Eleni ^{[8
]}

Spyropoulos, Alex C. ^{[1
,4
]}

机构：

[1] Northwell Hlth, Feinstein Inst Med Res, Inst Hlth Innovat & Outcomes Res, Manhasset, NY USA

[2] Univ Thessaly, Dept Vasc Surg, Larisa, Greece

[3] Donald & Barbara Zucker Sch Med Hofstra Northwell, Div Hematol, Hempstead, NY USA

[4] Donald & Barbara Zucker Sch Med Hofstra Northwell, Dept Med, Hempstead, NY USA

[5] Donald & Barbara Zucker Sch Med Hofstra Northwell, Dept Med, Div Rheumatol, Hempstead, NY USA

[6] Feinstein Inst Med Res, Inst Mol Med, Manhasset, NY USA

[7] Northwell Hlth, Dept Radiol, Manhasset, NY USA

[8] Univ Thessaly, Dept Anesthesiol, Larisa, Greece

来源：

BLOOD | 2021年 / 137卷 / 20期

关键词：

VENOUS THROMBOEMBOLISM;

D O I：

10.1182/blood.2020010529

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Thromboembolic events, including venous thromboembolism (VTE) and arterial thromboembolism (ATE), and mortality from subclinical thrombotic events occur frequently in coronavirus disease 2019 (COVID-19) inpatients. Whether the risk extends postdischarge has been controversial. Our prospective registry included consecutive patients with COVID-19 hospitalized within our multihospital system from 1 March to 31 May 2020. We captured demographics, comorbidities, laboratory parameters, medications, post-discharge thromboprophylaxis, and 90-day outcomes. Data from electronic health records, health informatics exchange, radiology database, and telephonic follow-up were merged. Primary outcome was a composite of adjudicated VTE, ATE, and all-cause mortality (ACM). Principal safety outcome was major bleeding (MB). Among 4906 patients (53.7% male), mean age was 61.7 years. Comorbidities included hypertension (38.6%), diabetes (25.1%), obesity (18.9%), and cancer history (13.1%). Postdischarge thromboprophylaxis was prescribed in 13.2%. VTE rate was 1.55%; ATE, 1.71%; ACM, 4.83%; and MB, 1.73%. Composite primary outcome rate was 7.13% and significantly associated with advanced age (odds ratio [OR], 3.66; 95% CI, 2.84-4.71), prior VTE (OR, 2.99; 95% CI, 2.00-4.47), intensive care unit (ICU) stay (OR, 2.22; 95% CI, 1.78-2.93), chronic kidney disease (CKD; OR, 2.10; 95% CI, 1.47-3.0), peripheral arterial disease (OR, 2.04; 95% CI, 1.10-3.80), carotid occlusive disease (OR, 2.02; 95% CI, 1.30-3.14), IMPROVE-DD VTE score >= 4 (OR, 1.51; 95% CI, 1.06-2.14), and coronary artery disease (OR, 1.50; 95% CI, 1.04-2.17). Postdischarge anticoagulation was significantly associated with reduction in primary outcome (OR, 0.54; 95% CI, 0.47-0.81). Postdischarge VTE, ATE, and ACM occurred frequently after COVID-19 hospitalization. Advanced age, cardiovascular risk factors, CKD, IMPROVE-DD VTE score >= 4 and ICU stay increased risk. Postdischarge anticoagulation reduced risk by 46%.

引用

页码：2838 / 2847

页数：10

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