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Article: Thrombotic risk in patients with COVID-19.

Pancaldi, Edoardo / Pascariello, Greta / Cimino, Giuliana / Cersosimo, Angelica / Amore, Ludovica / Alghisi, Fabio / Bernardi, Nicola / Calvi, Emiliano / Lombardi, Carlo Mario / Vizzardi, Enrico / Metra, Marco

Reviews in cardiovascular medicine

2021 Volume 22, Issue 2, Page(s) 277–286

Abstract: ... been performed in order to explore thrombotic risk in COVID-19 patients. Cytokine storm, mediated ... clarify the pathophysiological pathways underlying hypercoagulability in COVID-19 patients, providing ... Emerging evidences prove that the ongoing pandemic of coronavirus disease 2019 (COVID-19) is ...

Abstract	Emerging evidences prove that the ongoing pandemic of coronavirus disease 2019 (COVID-19) is strictly linked to coagulopathy even if pneumonia appears as the major clinical manifestation. The exact incidence of thromboembolic events is largely unknown, so that a relative significant number of studies have been performed in order to explore thrombotic risk in COVID-19 patients. Cytokine storm, mediated by pro-inflammatory interleukins, tumor necrosis factor α and elevated acute phase reactants, is primarily responsible for COVID-19-associated hypercoagulopathy. Also comorbidities, promoting endothelial dysfunction, contribute to a higher thromboembolic risk. In this review we aim to investigate epidemiology and clarify the pathophysiological pathways underlying hypercoagulability in COVID-19 patients, providing indications on the prevention of thromboembolic events in COVID-19. Furthermore we aim to reassume the pathophysiological paths involved in COVID-19 infection.
MeSH term(s)	Anticoagulants/therapeutic use ; Blood Coagulation/drug effects ; COVID-19/blood ; COVID-19/diagnosis ; COVID-19/drug therapy ; COVID-19/epidemiology ; Host-Pathogen Interactions ; Humans ; Prognosis ; Pulmonary Embolism/blood ; Pulmonary Embolism/epidemiology ; Pulmonary Embolism/prevention & control ; Pulmonary Embolism/virology ; Risk Assessment ; Risk Factors ; SARS-CoV-2/pathogenicity ; Venous Thromboembolism/blood ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/prevention & control ; Venous Thromboembolism/virology ; Venous Thrombosis/blood ; Venous Thrombosis/epidemiology ; Venous Thrombosis/prevention & control ; Venous Thrombosis/virology
Chemical Substances	Anticoagulants
Language	English
Publishing date	2021-07-14
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2108910-3
ISSN	1530-6550
ISSN	1530-6550
DOI	10.31083/j.rcm2202035
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Article ; Online: Secondary polycythemia in acutely ill COVID-19 patients is associated with higher mortality but not markedly higher thrombotic risk.

Lucijanic, Marko / Krecak, Ivan / Soric, Ena / Sabljic, Anica / Vasilj, Tamara / Cicic, David / Vrkljan Vuk, Anamarija / Kremer, Zvonimir / Dilber, Ivo / Glasnovic, Anton / Jaksic, Ozren / Kusec, Rajko

Scandinavian journal of clinical and laboratory investigation

2024 Volume 84, Issue 2, Page(s) 84–90

Abstract: ... a total of 5872 hospitalized COVID-19 patients with mostly severe and critical symptoms, and without prior ... However, its significance in the context of Coronavirus disease 2019 (COVID-19) is unknown. We retrospectively evaluated ... Secondary polycythemia is commonly observed among patients with chronic pulmonary diseases ...

Abstract	Secondary polycythemia is commonly observed among patients with chronic pulmonary diseases. However, its significance in the context of Coronavirus disease 2019 (COVID-19) is unknown. We retrospectively evaluated a total of 5872 hospitalized COVID-19 patients with mostly severe and critical symptoms, and without prior or subsequently diagnosed myeloproliferative neoplasm. Patients were stratified based on admission hemoglobin into four subgroups: anemia (hemoglobin <120 g/L for females and 130 g/L for males), normal hemoglobin, mild (hemoglobin 160-165 g/L for females and 165-185 g/L for males) and severe polycythemia (hemoglobin >165 g/L for females and >185 g/L for males). Among 5872 patients, a total of 158 (2.7%) had mild and 25 (0.4%) severe polycythemia. Polycythemia was significantly associated with higher respiratory and functional impairment, reduced plasma volume, higher serum osmolarity and comorbidity burden specific to the degree of polycythemia. Patients presenting with mild (odds ratio (OR) = 1.63,
MeSH term(s)	Humans ; COVID-19/complications ; COVID-19/mortality ; COVID-19/blood ; Polycythemia/blood ; Polycythemia/complications ; Female ; Male ; Middle Aged ; Aged ; Retrospective Studies ; Thrombosis/mortality ; Thrombosis/etiology ; Risk Factors ; SARS-CoV-2 ; Aged, 80 and over ; Comorbidity ; Hemoglobins/analysis ; Hemoglobins/metabolism
Chemical Substances	Hemoglobins
Language	English
Publishing date	2024-02-27
Publishing country	England
Document type	Journal Article
ZDB-ID	3150-1
ISSN	1502-7686 ; 0036-5513
ISSN (online)	1502-7686
ISSN	0036-5513
DOI	10.1080/00365513.2024.2321589
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Article ; Online: Thrombotic risk assessed by PAI-1 in patients with COVID-19: The influence of hyperglycemia and diabetes mellitus.

Basurto, Lourdes / Manuel-Apolinar, Leticia / Robledo, Ariadna / O'Leary, Sean / Martínez-Murillo, Carlos / Medina-Ortíz, Lina Ivette / Montes Osorio, Mario German / Zarazua, Julio / Balcázar-Hernández, Lourdes / Anda-Garay, Juan Carlos

Clinica e investigacion en arteriosclerosis : publicacion oficial de la Sociedad Espanola de Arteriosclerosis

2024

Abstract: Objective: To assess thrombotic risk with PAI-1 levels in patients with COVID-19, to evaluate PAI ... and T2DM.: Methods: A cross-sectional study carried out in 181 patients hospitalized for COVID-19 ... Patients hospitalized for COVID-19 infection with preexisting T2DM or hyperglycemia detected during ...

Abstract	Objective: To assess thrombotic risk with PAI-1 levels in patients with COVID-19, to evaluate PAI-1 differences between hyperglycemic and/or Type 2 Diabetes Mellitus (T2DM) versus non-hyperglycemic patients, and to analyze the association of plasminogen activator inhibitor-1 (PAI-1) with hyperglycemia and T2DM. Methods: A cross-sectional study carried out in 181 patients hospitalized for COVID-19. Two groups were formed: the patients with hyperglycemia at admission and/or previously diagnosed T2DM group and the non-hyperglycemic group. Fibrinolysis was assessed by measuring PAI-1 levels by ELISA. Results: The mean age was 59.4±16.1 years; 55.8% were male 54.1% of patients presented obesity, 38.1% had pre-existing T2DM and 50.8% had admission hyperglycemia and/or pre-existing T2DM. The patients with admission hyperglycemia and/or preexisting T2DM had higher PAI-1 compared with non-hyperglycemic patients [197.5 (128.8-315.9) vs 158.1 (113.4-201.4) ng/mL; p=0.031]. The glucose levels showed a positive correlation with PAI-1 levels (r=0.284, p=0.041). A multivariate logistic regression analysis showed association of PAI-1 level and hyperglycemia and pre-existing T2DM with severity of COVID-19. Conclusion: Patients hospitalized for COVID-19 infection with preexisting T2DM or hyperglycemia detected during their hospitalization presented a greater increase in PAI-1 levels, which suggests that hyperglycemia contributes directly to the hypercoagulable state and probably a worse outcome from the patients.
Language	Spanish
Publishing date	2024-01-11
Publishing country	Spain
Document type	Journal Article
ISSN	1578-1879
ISSN (online)	1578-1879
DOI	10.1016/j.arteri.2023.12.004
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Article: High Risk of Secondary Infections Following Thrombotic Complications in Patients With COVID-19.

Ripa, Marco / Galli, Laura / D'Angelo, Armando / Apruzzi, Luca / Palumbo, Diego / Campochiaro, Corrado / Tassan Din, Chiara / Danise, Anna / Da Prat, Valentina / Vitali, Giordano / Brugliera, Luigia / Poli, Andrea / Monardo, Roberta / Monti, Giacomo / Baccellieri, Domenico / De Cobelli, Francesco / Clementi, Massimo / Iannaccone, Sandro / Dagna, Lorenzo /

Rovere-Querini, Patrizia / Ciceri, Fabio / Tresoldi, Moreno / Zangrillo, Alberto / Scarpellini, Paolo / Castagna, Antonella

Open forum infectious diseases

2022 Volume 9, Issue 9, Page(s) ofac454

Abstract: ... PDFU, respectively (: Conclusions: In patients with COVID-19, thrombotic complications were ... of coronavirus disease 2019 (COVID-19) patients hospitalized at IRCCS San Raffaele Hospital between February 25 ... factors associated with risk of secondary infections.: Results: Overall, 109/904 patients had 176 ...

Abstract	Background: This study's primary aim was to evaluate the impact of thrombotic complications on the development of secondary infections. The secondary aim was to compare the etiology of secondary infections in patients with and without thrombotic complications. Methods: This was a cohort study (NCT04318366) of coronavirus disease 2019 (COVID-19) patients hospitalized at IRCCS San Raffaele Hospital between February 25 and June 30, 2020. Incidence rates (IRs) were calculated by univariable Poisson regression as the number of cases per 1000 person-days of follow-up (PDFU) with 95% confidence intervals. The cumulative incidence functions of secondary infections according to thrombotic complications were compared with Gray's method accounting for competing risk of death. A multivariable Fine-Gray model was applied to assess factors associated with risk of secondary infections. Results: Overall, 109/904 patients had 176 secondary infections (IR, 10.0; 95% CI, 8.8-11.5; per 1000-PDFU). The IRs of secondary infections among patients with or without thrombotic complications were 15.0 (95% CI, 10.7-21.0) and 9.3 (95% CI, 7.9-11.0) per 1000-PDFU, respectively ( Conclusions: In patients with COVID-19, thrombotic complications were associated with a high risk of secondary infections.
Language	English
Publishing date	2022-09-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofac454
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Article: Risk of Arterial and Venous Thrombotic Events Among Patients with COVID-19: A Multi-National Collaboration of Regulatory Agencies from Canada, Europe, and United States.

Lo Re Iii, Vincent / Cocoros, Noelle M / Hubbard, Rebecca A / Dutcher, Sarah K / Newcomb, Craig W / Connolly, John G / Perez-Vilar, Silvia / Carbonari, Dena M / Kempner, Maria E / Hernández-Muñoz, José J / Petrone, Andrew B / Pishko, Allyson M / Rogers Driscoll, Meighan E / Brash, James T / Burnett, Sean / Cohet, Catherine / Dahl, Matthew / DeFor, Terese A / Delmestri, Antonella /

Djibo, Djeneba Audrey / Duarte-Salles, Talita / Harrington, Laura B / Kampman, Melissa / Kuntz, Jennifer L / Kurz, Xavier / Mercadé-Besora, Núria / Pawloski, Pamala A / Rijnbeek, Peter R / Seager, Sarah / Steiner, Claudia A / Verhamme, Katia / Wu, Fangyun / Zhou, Yunping / Burn, Edward / Paterson, J Michael / Prieto-Alhambra, Daniel

Clinical epidemiology

2024 Volume 16, Page(s) 71–89

Abstract: Purpose: Few studies have examined how the absolute risk of thromboembolism with COVID-19 has ... the absolute risk of arterial (ATE) and venous thromboembolism (VTE) in the 90 days after diagnosis of COVID-19 ... before and during COVID-19 vaccine availability.: Patients and methods: We conducted cohort studies ...

Abstract	Purpose: Few studies have examined how the absolute risk of thromboembolism with COVID-19 has evolved over time across different countries. Researchers from the European Medicines Agency, Health Canada, and the United States (US) Food and Drug Administration established a collaboration to evaluate the absolute risk of arterial (ATE) and venous thromboembolism (VTE) in the 90 days after diagnosis of COVID-19 in the ambulatory (eg, outpatient, emergency department, nursing facility) setting from seven countries across North America (Canada, US) and Europe (England, Germany, Italy, Netherlands, and Spain) within periods before and during COVID-19 vaccine availability. Patients and methods: We conducted cohort studies of patients initially diagnosed with COVID-19 in the ambulatory setting from the seven specified countries. Patients were followed for 90 days after COVID-19 diagnosis. The primary outcomes were ATE and VTE over 90 days from diagnosis date. We measured country-level estimates of 90-day absolute risk (with 95% confidence intervals) of ATE and VTE. Results: The seven cohorts included 1,061,565 patients initially diagnosed with COVID-19 in the ambulatory setting before COVID-19 vaccines were available (through November 2020). The 90-day absolute risk of ATE during this period ranged from 0.11% (0.09-0.13%) in Canada to 1.01% (0.97-1.05%) in the US, and the 90-day absolute risk of VTE ranged from 0.23% (0.21-0.26%) in Canada to 0.84% (0.80-0.89%) in England. The seven cohorts included 3,544,062 patients with COVID-19 during vaccine availability (beginning December 2020). The 90-day absolute risk of ATE during this period ranged from 0.06% (0.06-0.07%) in England to 1.04% (1.01-1.06%) in the US, and the 90-day absolute risk of VTE ranged from 0.25% (0.24-0.26%) in England to 1.02% (0.99-1.04%) in the US. Conclusion: There was heterogeneity by country in 90-day absolute risk of ATE and VTE after ambulatory COVID-19 diagnosis both before and during COVID-19 vaccine availability.
Language	English
Publishing date	2024-02-10
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2494772-6
ISSN	1179-1349
ISSN	1179-1349
DOI	10.2147/CLEP.S448980
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Article ; Online: COVID-19: Not a thrombotic disease but a thromboinflammatory disease.

He, Shu / Blombäck, Margareta / Wallén, Håkan

Upsala journal of medical sciences

2024 Volume 129

Abstract: ... This study aims to reaffirm our previous hypothesis that COVID-19 is fundamentally a thrombotic disease ... to occurrence of thrombotic events. We therefrom understand that COVID-19 should no longer be viewed ... While Coronavirus Disease in 2019 (COVID-19) may no longer be classified as a global public health ...

Abstract	While Coronavirus Disease in 2019 (COVID-19) may no longer be classified as a global public health emergency, it still poses a significant risk at least due to its association with thrombotic events. This study aims to reaffirm our previous hypothesis that COVID-19 is fundamentally a thrombotic disease. To accomplish this, we have undertaken an extensive literature review focused on assessing the comprehensive impact of COVID-19 on the entire hemostatic system. Our analysis revealed that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection significantly enhances the initiation of thrombin generation. However, it is noteworthy that the thrombin generation may be modulated by specific anticoagulants present in patients' plasma. Consequently, higher levels of fibrinogen appear to play a more pivotal role in promoting coagulation in COVID-19, as opposed to thrombin generation. Furthermore, the viral infection can stimulate platelet activation either through widespread dissemination from the lungs to other organs or localized effects on platelets themselves. An imbalance between Von Willebrand Factor (VWF) and ADAMTS-13 also contributes to an exaggerated platelet response in this disease, in addition to elevated D-dimer levels, coupled with a significant increase in fibrin viscoelasticity. This paradoxical phenotype has been identified as 'fibrinolysis shutdown'. To clarify the pathogenesis underlying these hemostatic disorders in COVID-19, we also examined published data, tracing the reaction process of relevant proteins and cells, from ACE2-dependent viral invasion, through induced tissue inflammation, endothelial injury, and innate immune responses, to occurrence of thrombotic events. We therefrom understand that COVID-19 should no longer be viewed as a thrombotic disease solely based on abnormalities in fibrin clot formation and proteolysis. Instead, it should be regarded as a thromboinflammatory disorder, incorporating both classical elements of cellular inflammation and their intricate interactions with the specific coagulopathy.
MeSH term(s)	Humans ; COVID-19/complications ; SARS-CoV-2 ; Thrombin ; Thrombosis ; Blood Coagulation Disorders ; Inflammation ; Fibrin
Chemical Substances	Thrombin (EC 3.4.21.5) ; Fibrin (9001-31-4)
Language	English
Publishing date	2024-01-22
Publishing country	Sweden
Document type	Journal Article ; Review
ZDB-ID	183949-4
ISSN	2000-1967 ; 0300-9734
ISSN (online)	2000-1967
ISSN	0300-9734
DOI	10.48101/ujms.v129.9863
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Article ; Online: Risk of thrombotic complications in influenza versus COVID-19 hospitalized patients.

Stals, Milou A M / Grootenboers, Marco J J H / van Guldener, Coen / Kaptein, Fleur H J / Braken, Sander J E / Chen, Qingui / Chu, Gordon / van Driel, Erik M / Iglesias Del Sol, Antonio / de Jonge, Evert / Kant, K Merijn / Pals, Fleur / Toorop, Myrthe M A / Cannegieter, Suzanne C / Klok, Frederikus A / Huisman, Menno V

Research and practice in thrombosis and haemostasis

2021 Volume 5, Issue 3, Page(s) 412–420

Abstract: ... in patients with other respiratory tract infections are lacking. How this high risk in COVID-19 patients ... mainly driven by a high risk of VTC complications in the patients with COVID-19 admitted ... the cumulative incidence of thrombotic complications-adjusted for competing risk of death-in patients with COVID ...

Abstract	Background: Whereas accumulating studies on patients with coronavirus disease 2019 (COVID-19) report high incidences of thrombotic complications, large studies on clinically relevant thrombosis in patients with other respiratory tract infections are lacking. How this high risk in COVID-19 patients compares to those observed in hospitalized patients with other viral pneumonias such as influenza is unknown. Objectives: To assess the incidence of venous and arterial thrombotic complications in hospitalized patients with influenza as opposed to that observed in hospitalized patients with COVID-19. Methods: This was a retrospective cohort study; we used data from Statistics Netherlands (study period: 2018) on thrombotic complications in hospitalized patients with influenza. In parallel, we assessed the cumulative incidence of thrombotic complications-adjusted for competing risk of death-in patients with COVID-19 in three Dutch hospitals (February 24 to April 26, 2020). Results: Of the 13 217 hospitalized patients with influenza, 437 (3.3%) were diagnosed with thrombotic complications, versus 66 (11%) of the 579 hospitalized patients with COVID-19. The 30-day cumulative incidence of any thrombotic complication in influenza was 11% (95% confidence interval [CI], 9.4-12) versus 25% (95% CI, 18-32) in COVID-19. For venous thrombotic (VTC) complications and arterial thrombotic complications alone, these numbers were, respectively, 3.6% (95% CI, 2.7-4.6) and 7.5% (95% CI, 6.3-8.8) in influenza versus 23% (95% CI, 16-29) and 4.4% (95% CI, 1.9-8.8) in COVID-19. Conclusions: The incidence of thrombotic complications in hospitalized patients with influenza was lower than in hospitalized patients with COVID-19. This difference was mainly driven by a high risk of VTC complications in the patients with COVID-19 admitted to the Intensive Care Unit. Remarkably, patients with influenza were more often diagnosed with arterial thrombotic complications.
Language	English
Publishing date	2021-04-08
Publishing country	United States
Document type	Journal Article
ISSN	2475-0379
ISSN (online)	2475-0379
DOI	10.1002/rth2.12496
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Article ; Online: Association of COVID-19 vs Influenza With Risk of Arterial and Venous Thrombotic Events Among Hospitalized Patients.

JAMA

2022 Volume 328, Issue 7, Page(s) 637–651

Abstract: ... in patients with COVID-19 during vaccine availability (risk difference, 1.9% [95% CI, 1.1%-2.7%]). Compared ... 11.1%) in patients with COVID-19 during vaccine availability (risk difference, 5.5% [95% CI, 5.0%-6.1 ... with COVID-19 remains unclear.: Objective: To measure the 90-day risk of arterial thromboembolism and ...

Abstract	Importance: The incidence of arterial thromboembolism and venous thromboembolism in persons with COVID-19 remains unclear. Objective: To measure the 90-day risk of arterial thromboembolism and venous thromboembolism in patients hospitalized with COVID-19 before or during COVID-19 vaccine availability vs patients hospitalized with influenza. Design, setting, and participants: Retrospective cohort study of 41 443 patients hospitalized with COVID-19 before vaccine availability (April-November 2020), 44 194 patients hospitalized with COVID-19 during vaccine availability (December 2020-May 2021), and 8269 patients hospitalized with influenza (October 2018-April 2019) in the US Food and Drug Administration Sentinel System (data from 2 national health insurers and 4 regional integrated health systems). Exposures: COVID-19 or influenza (identified by hospital diagnosis or nucleic acid test). Main outcomes and measures: Hospital diagnosis of arterial thromboembolism (acute myocardial infarction or ischemic stroke) and venous thromboembolism (deep vein thrombosis or pulmonary embolism) within 90 days. Outcomes were ascertained through July 2019 for patients with influenza and through August 2021 for patients with COVID-19. Propensity scores with fine stratification were developed to account for differences between the influenza and COVID-19 cohorts. Weighted Cox regression was used to estimate the adjusted hazard ratios (HRs) for outcomes during each COVID-19 vaccine availability period vs the influenza period. Results: A total of 85 637 patients with COVID-19 (mean age, 72 [SD, 13.0] years; 50.5% were male) and 8269 with influenza (mean age, 72 [SD, 13.3] years; 45.0% were male) were included. The 90-day absolute risk of arterial thromboembolism was 14.4% (95% CI, 13.6%-15.2%) in patients with influenza vs 15.8% (95% CI, 15.5%-16.2%) in patients with COVID-19 before vaccine availability (risk difference, 1.4% [95% CI, 1.0%-2.3%]) and 16.3% (95% CI, 16.0%-16.6%) in patients with COVID-19 during vaccine availability (risk difference, 1.9% [95% CI, 1.1%-2.7%]). Compared with patients with influenza, the risk of arterial thromboembolism was not significantly higher among patients with COVID-19 before vaccine availability (adjusted HR, 1.04 [95% CI, 0.97-1.11]) or during vaccine availability (adjusted HR, 1.07 [95% CI, 1.00-1.14]). The 90-day absolute risk of venous thromboembolism was 5.3% (95% CI, 4.9%-5.8%) in patients with influenza vs 9.5% (95% CI, 9.2%-9.7%) in patients with COVID-19 before vaccine availability (risk difference, 4.1% [95% CI, 3.6%-4.7%]) and 10.9% (95% CI, 10.6%-11.1%) in patients with COVID-19 during vaccine availability (risk difference, 5.5% [95% CI, 5.0%-6.1%]). Compared with patients with influenza, the risk of venous thromboembolism was significantly higher among patients with COVID-19 before vaccine availability (adjusted HR, 1.60 [95% CI, 1.43-1.79]) and during vaccine availability (adjusted HR, 1.89 [95% CI, 1.68-2.12]). Conclusions and relevance: Based on data from a US public health surveillance system, hospitalization with COVID-19 before and during vaccine availability, vs hospitalization with influenza in 2018-2019, was significantly associated with a higher risk of venous thromboembolism within 90 days, but there was no significant difference in the risk of arterial thromboembolism within 90 days.
MeSH term(s)	Aged ; Aged, 80 and over ; COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19 Vaccines/therapeutic use ; Female ; Hospitalization/statistics & numerical data ; Humans ; Incidence ; Influenza, Human/epidemiology ; Ischemic Stroke/epidemiology ; Male ; Middle Aged ; Myocardial Infarction/epidemiology ; Public Health Surveillance ; Pulmonary Embolism/epidemiology ; Retrospective Studies ; Risk ; Risk Assessment ; Thromboembolism/epidemiology ; Thrombosis/epidemiology ; United States/epidemiology ; Venous Thrombosis/epidemiology
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-08-16
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2022.13072
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Article ; Online: Prevention of thrombotic risk in hospitalized patients with COVID-19 and hemostasis monitoring.

Susen, Sophie / Tacquard, Charles Ambroise / Godon, Alexandre / Mansour, Alexandre / Garrigue, Delphine / Nguyen, Philippe / Godier, Anne / Testa, Sophie / Levy, Jerrold H / Albaladejo, Pierre / Gruel, Yves

Critical care (London, England)

2020 Volume 24, Issue 1, Page(s) 364

Abstract: ... patients with COVID-19.Four levels of thromboembolic risk were defined according to the severity of COVID ... with a higher risk of thrombosis, particularly pulmonary embolism. The impact of obesity in severe COVID-19 has ... 19 reflected by oxygen requirement and treatment, the body mass index, and other risk ...

Abstract	COVID-19 is an infection induced by the SARS-CoV-2 coronavirus, and severe forms can lead to acute respiratory distress syndrome (ARDS) requiring intensive care unit (ICU) management. Severe forms are associated with coagulation changes, mainly characterized by an increase in D-dimer and fibrinogen levels, with a higher risk of thrombosis, particularly pulmonary embolism. The impact of obesity in severe COVID-19 has also been highlighted.In this context, standard doses of low molecular weight heparin (LMWH) may be inadequate in ICU patients, with obesity, major inflammation, and hypercoagulability. We therefore urgently developed proposals on the prevention of thromboembolism and monitoring of hemostasis in hospitalized patients with COVID-19.Four levels of thromboembolic risk were defined according to the severity of COVID-19 reflected by oxygen requirement and treatment, the body mass index, and other risk factors. Monitoring of hemostasis (including fibrinogen and D-dimer levels) every 48 h is proposed. Standard doses of LMWH (e.g., enoxaparin 4000 IU/24 h SC) are proposed in case of intermediate thrombotic risk (BMI < 30 kg/m
MeSH term(s)	COVID-19 ; Coronavirus Infections/physiopathology ; Coronavirus Infections/therapy ; Hemostasis/physiology ; Hospitalization ; Humans ; Monitoring, Physiologic ; Pandemics ; Pneumonia, Viral/physiopathology ; Pneumonia, Viral/therapy ; Risk ; Thrombosis/prevention & control
Keywords	covid19
Language	English
Publishing date	2020-06-19
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2041406-7
ISSN	1466-609X ; 1364-8535
ISSN (online)	1466-609X
ISSN	1364-8535
DOI	10.1186/s13054-020-03000-7
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Article ; Online: Characterizing Thrombotic Complication Risk Factors Associated With COVID-19 via Heterogeneous Patient Data: Retrospective Observational Study.

Rosario, Bedda / Zhang, Andrew / Patel, Mehool / Rajmane, Amol / Xie, Ning / Weeraratne, Dilhan / Alterovitz, Gil

Journal of medical Internet research

2022 Volume 24, Issue 10, Page(s) e35860

Abstract: ... on thrombotic complications in patients with COVID-19 with respect to patient demographic and clinical factors ... P<.001) for thrombotic complications in 184,831 COVID-19 patients out of the millions of records ... burden in patients with COVID-19. However, venous thromboembolism, arterial thrombosis, and ...

Abstract	Background: COVID-19 has been observed to be associated with venous and arterial thrombosis. The inflammatory disease prolongs hospitalization, and preexisting comorbidities can intensity the thrombotic burden in patients with COVID-19. However, venous thromboembolism, arterial thrombosis, and other vascular complications may go unnoticed in critical care settings. Early risk stratification is paramount in the COVID-19 patient population for proactive monitoring of thrombotic complications. Objective: The aim of this exploratory research was to characterize thrombotic complication risk factors associated with COVID-19 using information from electronic health record (EHR) and insurance claims databases. The goal is to develop an approach for analysis using real-world data evidence that can be generalized to characterize thrombotic complications and additional conditions in other clinical settings as well, such as pneumonia or acute respiratory distress syndrome in COVID-19 patients or in the intensive care unit. Methods: We extracted deidentified patient data from the insurance claims database IBM MarketScan, and formulated hypotheses on thrombotic complications in patients with COVID-19 with respect to patient demographic and clinical factors using logistic regression. The hypotheses were then verified with analysis of deidentified patient data from the Research Patient Data Registry (RPDR) Mass General Brigham (MGB) patient EHR database. Data were analyzed according to odds ratios, 95% CIs, and P values. Results: The analysis identified significant predictors (P<.001) for thrombotic complications in 184,831 COVID-19 patients out of the millions of records from IBM MarketScan and the MGB RPDR. With respect to age groups, patients 60 years and older had higher odds (4.866 in MarketScan and 6.357 in RPDR) to have thrombotic complications than those under 60 years old. In terms of gender, men were more likely (odds ratio of 1.245 in MarketScan and 1.693 in RPDR) to have thrombotic complications than women. Among the preexisting comorbidities, patients with heart disease, cerebrovascular diseases, hypertension, and personal history of thrombosis all had significantly higher odds of developing a thrombotic complication. Cancer and obesity were also associated with odds>1. The results from RPDR validated the IBM MarketScan findings, as they were largely consistent and afford mutual enrichment. Conclusions: The analysis approach adopted in this study can work across heterogeneous databases from diverse organizations and thus facilitates collaboration. Searching through millions of patient records, the analysis helped to identify factors influencing a phenotype. Use of thrombotic complications in COVID-19 patients represents only a case study; however, the same design can be used across other disease areas by extracting corresponding disease-specific patient data from available databases.
MeSH term(s)	Humans ; Female ; COVID-19/complications ; COVID-19/epidemiology ; Thrombosis/epidemiology ; Thrombosis/etiology ; Risk Factors ; Retrospective Studies ; Odds Ratio
Language	English
Publishing date	2022-10-21
Publishing country	Canada
Document type	Observational Study ; Journal Article
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1439-4456
ISSN (online)	1438-8871
ISSN	1439-4456
DOI	10.2196/35860
Database	MEDical Literature Analysis and Retrieval System OnLINE

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