key: cord-0770504-c9g4ube7
authors: Mukherjee, Amrita; Pakhchanian, Haig; Raiker, Rahul; Singh, Shailendra; Chatterjee, Arka
title: Burden of Thrombotic Events in Coronavirus Disease-19 (COVID-19) Patients and Effect on Outcomes (from a Multicenter Electronic Health Record Database)
date: 2021-03-06
journal: Am J Cardiol
DOI: 10.1016/j.amjcard.2021.03.003
sha: fb885dc5917bf9234f97ea9ea692b23bffee5d14
doc_id: 770504
cord_uid: c9g4ube7

nan

Coronavirus disease-19 (Covid-19) patients have been postulated to have high risk of thrombotic events (TE). There are variable estimates of the rate of TE with COVID-19 and derived from hospital case series mostly. 1,2 Data on unfavorable outcomes, including mortality in Covid-19 patients with TE are limited. We use a large electronic health record (EHR) database to investigate these questions.

Our clinical cohort included patients ≥18 years of age diagnosed with COVID-19 between January 20, 2020 and September 10, 2020. Covid-19 patients were identified via real-time search and analysis of more than 49 million patients from 33 healthcare organizations participating in a global health research network called TriNetX (Cambridge, MA). COVID-19 diagnosis was confirmed using specific COVID-19 diagnosis criteria recommended by the World Health Organization and Centers for Disease Control. COVID-19 patients were divided into two cohort (TE / no TE), based on presence of TE within 30 days of COVID-19 diagnosis. Validated ICD-10 diagnosis codes were used to identify TE (acute myocardial infarction-AMI, pulmonary embolism-PE, cerebro-vascular accident -CVA, peripheral arterial thrombosis, and deep venous thrombosis-DVT). Propensity score matching was performed for age, gender and race. Primary outcome tested was 30-day all-cause mortality post COVID-19 diagnosis.

Secondary outcomes included hospitalization, need for mechanical ventilation, hemodialysis, continuous renal replacement therapy-CRRT, acute respiratory distress syndrome-ARDS and acute kidney injury. All statistical analyses were performed using TriNetX with standard methodology previously reported. 3 A total of 120, 515 COVID-19 patients were identified including 4140 with TE (3.4%) − 1526: AMI, DVT − 1530, PE: 1140, CVA − 1014, peripheral arterial thrombosis: 140. Patients with TE were more likely to be male (p < 0.001), black (p < 0.001) and older (63.6 § 15.9 vs 47.1 § 18.7, p < 0.001). Table 1 shows the outcomes before and after propensity matching. Previous studies have reported 16% to 31% of COVID-19 patients to have some form of TE/complications and higher mortality in Covid-19 patients with TE. 1, 4 Our data from a very large sample of all-comers COVID-19 patients (including outpatients) shows a smaller prevalence of TE. This also provides more comprehensive estimates of the increased risk of worse outcomes including mortality in COVID-19 patients with TE events and underscores the need for intensive screening and thromboprophylaxis in these patients. Our study is limited because of not accounting for comorbidities / anticoagulation or anti-platelet therapy − however, it still represents a broad 

outline of the burden of TE in the largest sample of COVID-19 patients so far reported.

Thrombosis in hospitalized patients with COVID-19 in a New York City health system

COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection

Outcomes of COVID-19 in CKD patients: a multicenter electronic medical record cohort study

Thromboembolic disease in COVID-19 patients: a brief narrative review

ARTICLE IN PRESS 2 The American Journal of Cardiology

We acknowledge the West Virginia Clinical and Translational Science Institute (Morgantown, WV) in providing us access and training to the TriNetX federated healthcare network.Amrita Mukherjee, MPH a Haig Pakhchanian, BS b Rahul Raiker, BS c Shailendra Singh, MD d