Abstract 13121: Incidence, Predictors, and Outcomes of Venous and Arterial Thrombosis in COVID-19: A Nationwide Analysis

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) is known to increase the risk of venous (VTE) and arterial (ATE) thromboembolism. However, the incidence, predictors, and outcomes of clinical thrombosis for inpatients with COVID-19 are not well known. We evaluated the incidence, associated factors, and mortality outcomes of VTE and ATE in COVID-19 infection. Hypothesis: COVID-19 is associated with a higher risk of thrombosis and mortality. Methods: Hospitalized patients with COVID-19 during 2020 were identified from the National Inpatient Sample database and data was retrieved regarding clinical characteristics, incident VTE and ATE and mortality outcomes. Multivariate regression was performed to identify clinical factors associated with thrombosis and in-hospital mortality in COVID-19 inpatients. Results: Overall, 1,583,135 COVID-19 inpatients were identified out of which patients with thrombosis were 41% females with a mean age 65.4 (65.1-65.6) years. The incidence of thrombosis was 6.1%, including VTE 4.8%, ATE 3.0%, and in-hospital mortality rate was 13.4%. The main factors associated with overall thrombosis, VTE and ATE were paralysis, ventilation, solid tumors without metastasis, and metastatic cancer. Patients with thrombosis were more likely to have respiratory symptoms of COVID-19 (76.7% vs 75%, p<0.001) compared to patients without thrombosis, along with comorbidities like complicated diabetes mellitus and congestive heart failure, and acute presentations like septic shock, acute respiratory distress syndrome and acute kidney injury. Symptomatic and severe COVID-19 disease were associated with a higher risk of thrombosis (OR 1.37 (1.31-1.43) and OR 1.62 (1.49-1.76), respectively, p<0.001) and VTE (OR 1.40 (1.33-1.46) and OR 1.66 (1.52-1.80) respectively, p<0.001). Although all thrombosis categories were associated with higher in-hospital mortality for COVID-19 inpatients in univariable analyses (p<0.001), they were not significant in multivariate analyses. Conclusions: Overall, thrombosis, especially VTE was found in approximately 5% of COVID-19 inpatients, while ATE was rare, with important associated factors identified, however they were not independently associated with higher in-hospital mortality.