A cohort population-wide study finds an increase in major arterial and venous thrombotic events immediately upon diagnosis of COVID-19

In a recent study published in RotationIn this study, researchers explored the relationship between coronavirus disease 2019 (COVID-19) and vascular thrombotic events using a population-wide cohort study across England and Wales.

background

The COVID-19 pandemic caused by the coronavirus 2 (SARS-CoV-2) has had long-term consequences for human health, with patients experiencing significant reduced physical fitness, cognitive impairment and heart problems months after discharge from hospital. from the hospital.

Studies have shown that SARS-CoV-2 infection caused a proinflammatory and thrombotic state with marked increases in arterial and venous thrombotic events. However, there is no detailed analysis of the long-term risks of SARS-CoV-2 for vascular diseases and their associations with demographic characteristics and comorbidities.

about studying

The current study compared COVID-19 diagnostic data with major VTE cases using population-wide electronic health records between 1 January and 7 December 2020, from England and Wales.

Comparisons were made on the basis of gender, age, and ethnicity. The incidence of arterial and venous thrombosis was estimated in COVID-19 patients with and without hospitalization and in persons not diagnosed with COVID-19. Positive polymerase chain reaction (PCR) or antigen A confirmed test or diagnosis from a primary or secondary care facility was used to determine diagnoses of COVID-19.

Outcomes examined included arterial thrombosis such as myocardial infarction and stroke, venous thromboembolic events such as pulmonary embolism and deep venous thrombosis, and other vascular events including transient ischemic attack, intracerebral or subarachnoid hemorrhage, and angina pectoris.

Hazard ratios were estimated by comparing the incidence of thrombotic events in individuals with a diagnosis of COVID-19 and individuals without a diagnosis of COVID-19.

consequences

The results indicated a significant increase in the incidence of arterial thrombosis and venous thromboembolism in people diagnosed with COVID-19 compared to individuals not diagnosed with COVID-19, both of which decreased over time.

A total of 48 million people were included in the cohort study, and the number of people with COVID-19 diagnosed in hospital who had not been hospitalized at 28 days after diagnosis was 125,985 and 1,319,789, respectively. The incidence of stroke was higher, and the decline in numbers was slower in hospitalized COVID-19 patients than in non-hospitalized individuals.

Demographic factors such as age and gender do not appear to influence the incidence of thrombotic events. However, race appears to have been a significant factor, as people of black and Asian race had a higher incidence of thrombotic events than white people. The authors believe that the association of race with increased thrombotic events and higher mortality rates associated with COVID-19 is influenced by factors such as occupation, living conditions, deprivation, and pre-existing health conditions, among others.

In a follow-up of 41.6 million people in England, the number of first arterial thrombosis and venous thromboembolism was 260,279 and 59,421, respectively. Adjusted hazard ratios for comparisons of arterial thrombosis with and without COVID-19 diagnoses decreased from 21.7 to 1.34 from week 1 to week 27-49. Similarly, the hazard ratios for venous thrombosis events decreased from 33.2 to 1.80 in the same duration.

Among the population, a 0.5% increase in the risk of arterial thromboembolism and a 0.25% increase in the risk of venous thromboembolism were observed, which corresponds to, in 1.4 million diagnosed cases of COVID-19, 7,200 and 3,500 cases of arterial and venous thromboembolism, respectively.

Conclusions

Overall, the study reported a significant increase in the incidence of arterial and venous thromboembolism in the weeks following the diagnosis of COVID-19 in England and Wales, with numbers decreasing over time, albeit relatively slower in venous thromboembolism.

The findings highlight the need to use COVID-19 vaccines to prevent severe disease manifestations requiring hospitalization, as the incidence of major thrombotic events was higher among hospitalized COVID-19 patients than among those not hospitalized.

Furthermore, the authors believe that patients discharged from hospital after acute COVID-19, especially cases of high-risk vascular disease, need to be prescribed secondary prophylactic therapies to reduce infection-related thrombotic events and to educate them about the importance of reviews and follow-ups after hospital discharge.

Given the rapidly evolving variables showing immune evasion and emerging data on various post-COVID-19 complications, there is an urgent need for improved vaccines and therapies to reduce the severity of COVID-19, as well as new treatment approaches to reduce infection-associated thrombotic events.