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

被引:126
|
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
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
收藏
页码:2838 / 2847
页数:10
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