Abstract
• Several cardiovascular/hemostatic disturbances haves been reported in patients with COVID-19, but the real frequency and their potential association with the pathogenic mechanisms of SARS-CoV-19 still remain to be defined. • We investigated the relative frequency of acute coronary syndrome, deep venous thrombosis, pulmonary embolism, stroke and upper gastrointestinal bleeding in COVID patents attending emergency departments (EDs), before hospitalization and compared them with frequencies in the general ED population attending 50 Spanish EDs. • We found that the risk of pulmonary embolism is clearly increased in COVID patients, with an OR of 4.53 with respect to non-COVID patients (95% confidence interval 4.03- 5.10). Additionally, the diagnosis of pulmonary embolism was 2 fold more frequent among ED comers in 2020 compared to 2019, suggesting a SARS-CoV-2 role in such increment of cases.. The remaining entities studied were not found to be unequivocally increased in the present study and need further investigation.
Highlights
Infection by SARS-Cov-2 is mainly characterized by fever and respiratory symptoms, with dyspnea and lung infiltrates in more severe cases [1,2]
We identified 99 acute coronary syndrome (ACS), 69 deep venous thrombosis (DVT) (1.08‰, 1.57- 1.72), 353 pulmonary embolism (PE) (5.53‰, 4.97–6.14), 134 strokes (2.11‰, 1.77–2.49; 85% ischemic and 15% hemorrhagic) and 73 upper gastrointestinal bleeding (UGB) (1.14‰, 0.90- 1.44)
SARSCoV-2 infection was demonstrated in 76% of these cases by polymerase chain reaction (PCR) in nasopharyngeal swear, while diagnosis was established based on signs/symptoms of COVID-19 and/or in typical chest X-ray or computerized tomography findings in the remaining 24%, taking into account the epidemiological context of the enormous number of people infected by SARS-CoV-2 and the shortage of PCR tests experienced worldwide in March–April 2020
Summary
Infection by SARS-Cov-2 is mainly characterized by fever and respiratory symptoms, with dyspnea and lung infiltrates in more severe cases [1,2]. Many patients present a pro-coagulant state, which is biochemically detected by increased D-dimer levels and is related to complications and a worse prognosis [1,3] In this context, isolated case reports and short case series have suggested an increased risk of patients with COVID-19 to develop clinically relevant cardiovascular and hemostatic disturbances [3,4,5,6,7]. Many of these reports refer to hospitalized patients, and as hospitalization itself usually increases complications in bedridden patients with multidrug treatment or in very poor condition, it is unknown if such cardiovascular/hemostatic processes are related to the pathogenesis of SARS-Cov-2.
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