Ann Vasc Surg. 2022 May 16:S0890-5096(22)00234-5. doi: 10.1016/j.avsg.2022.04.048. Online ahead of print.
OBJECTIVE: The primary objective of this study is to assess the risk of thromboembolic events in hospitalized patients with COVID-19 and study the impact of thromboembolic events on hospital course and mortality risk during the initial height of the SARS-CoV-2 pandemic.
METHODS: A retrospective review of all adult inpatients (≥18 years old) with COVID-19 infection at a single academic institution from March 15, 2020 - July 1, 2020 was performed. Collected data included patient demographics, comorbidities, hospital admission type, thromboembolic events, laboratory values, use of anticoagulants/antiplatelet agents, hospital length of stay, and in-hospital mortality. Logistic regression was used to estimate associations between risk factors and thromboembolic events.
RESULTS: A total of 826 inpatients with COVID-19 were identified. Of these, 56% were male, average age was 60.9 years, and race/ethnicity was reported as % Hispanic in 51%, non-Hispanic Black in 25% and non-Hispanic White in 18%. A total of 98 thromboembolic events were documented in 87 patients (10.5%). Hypertension, coronary artery disease, and chronic limb threatening ischemia were associated with an increased incidence of thromboembolism (p < 0.05). Hispanic patients had higher incidence of thromboembolism compared to White non-Hispanic patients [OR (CI): 2.237 (1.053, 4.754), p = 0.036]. As D-dimer increased, the odds of thromboembolic event increased by 5.2% [OR (CI): 1.052 (1.027, 1.077), p < 0.001]. Patients with thromboembolic events had longer hospital stay (Median 13 vs. 6 days, p < 0.001), higher likelihood of ICU admission (63% vs 33%, p < 0.001), and higher in-hospital mortality (28% vs 16%, p = 0.006). Arterial thromboembolic events were associated with higher in-hospital mortality than venous thromboembolic events (37% vs 15%, p = 0.027).
CONCLUSION: During the initial height of the SARS-CoV-2 pandemic, thromboembolic events were relatively frequent in hospitalized patients with COVID-19. Racial disparities were seen with an increased proportion of minority patients admitted with respect to percentages seen in the general population, There was also significantly increased incidence of thromboembolic events in Hispanic patients. Thromboembolic events were associated with significantly longer hospital stay and higher in-hospital mortality. Patients with arterial thromboembolic events fared worse with significantly higher mortality than those with venous events. Inconsistencies in anticoagulation management early in the pandemic may have contributed to poor outcomes and more contemporary management outcomes need to be investigated.