Abstract
BackgroundStudies have reported COVID-19 as an independent risk factor for arterial thromboemboli.MethodsFrom a cross-sectional sample, we determined the incidence and location of arterial thromboemboli (myocardial infarction, ischemic stroke, peripheral artery), stratified by COVID-19 status, in the RECOVER database, which included data on patients at 45 United States medical centers in 22 states. Epidemiological factors, clinical characteristics and outcomes were collected through a combination of individual chart review and automatic electronic query and recorded in REDCap®. We investigated the association of baseline comorbidities on the development of arterial thromboemboli and analyzed results based on the presence or absence of concomitant COVID-19 infection, testing this association with Chi-squared. We also described use of anticoagulants and statins.ResultsData were collected on 26,974 patients, of which 13,803 (51.17%) tested positive for COVID-19. Incidence of arterial thromboemboli during hospitalization was 0.13% in patients who tested positive for COVID-19 and 0.19% in patients who tested negative. Arterial thromboemboli tended to be more common in extremities than in core organs (heart, kidney, lung, liver) in patients with COVID-19, odds ratio 2.04 (95% CI 0.707 – 5.85). Patients with COVID-19 were less likely to develop an arterial thrombus when on baseline statin medication (p=0.014). Presence of metabolic syndrome predicted presence of core arterial thrombus (p=0.001) and extremity arterial thrombus (p=0.010) in those with COVID-19. Arterial thromboemboli were less common in patients with COVID-19 than in those who tested negative for COVID-19.ConclusionsPresence of a composite metabolic syndrome profile may be associated with arterial clot formation in patients with COVID-19 infection.
Highlights
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, studies have reported increased incidence of arterial thromboemboli, prognosticating poor outcomes in patients infected with COVID-19.[1,2,3,4,5] Researchers speculated that SARS-CoV-2 infects endothelial cells through the angiotensin-converting enzyme 2 receptor leading to arterial thromboemboli.[6, 7]
We investigated the association of various baseline comorbidities on the development of arterial thrombus and analyzed results based on the presence or absence of concomitant COVID-19 infection, testing this association with the Pearson’s Chi-squared
Patients who tested positive for COVID-19 were older and less likely to be of White race than those who tested negative (P
Summary
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, studies have reported increased incidence of arterial thromboemboli, prognosticating poor outcomes in patients infected with COVID-19.[1,2,3,4,5] Researchers speculated that SARS-CoV-2 infects endothelial cells through the angiotensin-converting enzyme 2 receptor leading to arterial thromboemboli.[6, 7] reports describing the incidence of arterial thromboemboli vary, [2, 7, 8], and the mechanisms leading to occurrence of arterial thromboemboli in those patients remain unclear.Many studies investigating arterial thromboemboli are small retrospective studies or case series.[2, 9] As arterial thromboemboli are uncommon,[2] small studies are extremely limited in their ability to describe patterns in those patients. Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, studies have reported increased incidence of arterial thromboemboli, prognosticating poor outcomes in patients infected with COVID-19.[1,2,3,4,5] Researchers speculated that SARS-CoV-2 infects endothelial cells through the angiotensin-converting enzyme 2 receptor leading to arterial thromboemboli.[6, 7] reports describing the incidence of arterial thromboemboli vary, [2, 7, 8], and the mechanisms leading to occurrence of arterial thromboemboli in those patients remain unclear. Though the overall incidence is low, arterial thromboemboli remain a critical complication of infection with COVID-19. Understanding factors contributing to arterial thromboemboli in patients with COVID-19 remains of great importance. Studies have reported COVID-19 as an independent risk factor for arterial thromboemboli
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