Population-wide cohort study detects increase in major arterial and venous thrombotic events immediately after COVID-19 diagnoses


In a recently published study in TrafficResearchers examined the association between coronavirus disease 2019 (COVID-19) and vascular thrombotic events using a population-wide cohort study in England and Wales.

Study: Association of COVID-19 with major arterial and venous thrombotic disease: A population-wide cohort study of 48 million adults in England and Wales.  Credit: MattLphotography/Shutterstock
Study: Association of COVID-19 with major arterial and venous thrombotic disease: A population-wide cohort study of 48 million adults in England and Wales. Credit: MattLphotography/Shutterstock

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The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in long-lasting human health consequences, with patients experiencing marked declines in fitness, cognitive impairment and heart problems months after discharge from the hospital.

Studies have shown that SARS-CoV-2 infection induces a proinflammatory and prothrombotic state with a notable increase in arterial and venous thrombotic events. However, a detailed analysis of the SARS-CoV-2-induced long-term risk of vascular disease and its associations with demographic characteristics and comorbidities is lacking.

About the study

The present study compared COVID-19 diagnostic data with incidences of major vascular thrombosis using population-wide electronic medical records between 1 January and 7 December 2020 from England and Wales.

Comparisons were made based on sex, age and race. Incidences of arterial and venous thrombosis were estimated in hospitalized and unhospitalized COVID-19 patients and in those without a COVID-19 diagnosis. A positive polymerase chain reaction (PCR) or antigen test or a confirmed diagnosis from a primary or secondary care facility was used to identify COVID-19 diagnoses.

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Outcomes examined included arterial thrombosis such as myocardial infarction and ischemic stroke, venous thromboembolic events such as pulmonary embolism and deep vein thrombosis, and other vascular events such as transient ischemic attacks, intracerebral or subarachnoid hemorrhage, and angina pectoris.

The hazard ratios were estimated by comparing the incidence of vascular thrombotic events in subjects diagnosed with COVID-19 and subjects not diagnosed with COVID-19.

Results

The results showed a significant increase in the incidence of arterial thrombosis and venous thromboembolism in people diagnosed with COVID-19 compared to people without a COVID-19 diagnosis, both of which decreased over time.

A total of 48 million people were included in the cohort study, of which the number of people with COVID-19 diagnosis who were hospitalized and not hospitalized in the 28 days after diagnosis were 125985 and 1319789, respectively. The incidence of thrombotic events was higher in hospitalized COVID-19 patients and the decline in numbers was slower than in non-hospitalized individuals.

Demographic factors such as age and gender did not appear to affect the incidence of thrombotic events. However, race appeared to be an important factor, with people of black and Asian ethnicities having a higher incidence of thrombotic events than white people. The authors believe that race’s association with increases in thrombotic events and higher rates of COVID-19-related mortality is influenced by factors such as occupation, living conditions, deprivation, and pre-existing health problems, among others.

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In the 41.6 million person-year follow-up in England, the number of first-time arterial thrombosis and venous thromboembolism were 260,279 and 59,421, respectively. The adjusted hazard ratios for comparisons of arterial thrombosis with and without a diagnosis of COVID-19 decreased from 21.7 to 1.34 from week 1 to week 27-49. Likewise, the hazard ratios for venous thrombotic events decreased from 33, 2 to 1.80.

Across the population, a 0.5% increased risk of arterial thrombosis and a 0.25% increased risk of venous thromboembolism were observed, corresponding to 7,200 and 3,500 arterial and venous thrombotic events, respectively, in 1.4 million COVID-19 diagnoses.

Conclusions

Overall, the study reported a significant increase in the incidence of arterial and venous thrombotic events in the weeks following COVID-19 diagnosis in England and Wales, with numbers decreasing over time, albeit comparatively more slowly for venous thromboembolism.

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The results underscore the need to use COVID-19 vaccines to prevent severe disease manifestations that require hospitalization, as the incidence of major thrombotic events was higher in COVID-19 patients who were hospitalized than those who who were not hospitalized.

In addition, the authors believe that patients discharged after severe COVID-19, particularly cases of high-risk vascular disease, need to be prescribed secondary preventive therapies to reduce infection-associated thrombotic events and that they reflect on the importance of review and follow-up must be clarified before the dismissal.

With rapidly evolving variants that exhibit immune evasion and emerging data on the various post-COVID-19 complications, there is an urgent need for improved vaccines and therapies to reduce the severity of COVID-19, as well as new treatments to reduce infections. associated thrombotic events.

Magazine reference:

  • Knight R, Walker V, Ip S, Cooper JA, Bolton T, Keene S, Denholm R, Akbari A, Abbasizanjani H, Torabi F, Omigie , E., Hollings, S., North, T.-L., Toms, R., Jiang, X., Angelantonio, E.D., Denaxas, S., Thygesen, J.H., Tomlinson, C., & Bray, B. (2022). Association of COVID-19 with major arterial and venous thrombotic disease: A population-wide cohort study of 48 million adults in England and Wales. Traffic. doi: https://doi.org/10.1161/circulationaha.122.060785 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.060785



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