In a recent study published in Circulation, researchers explored 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. Image credit: MattLphotography/Shutterstock
background
The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had lasting consequences on human health, with patients experiencing marked reductions in fitness, cognitive impairment and heart problems for months after being discharged. from the hospital
Studies have shown that SARS-CoV-2 infection induced a proinflammatory and prothrombotic state with marked increases in arterial and venous thrombotic events. However, a detailed analysis of the long-term risk of vascular disease induced by SARS-CoV-2 and its associations with demographic characteristics and comorbidities is lacking.
About the study
The present study compared COVID-19 diagnosis data with the incidence of major vascular thrombosis using electronic health records for the entire population between 1 January and 7 December 2020, from England and Wales.
Comparisons were made based on sex, age, and race. We estimated the incidences of arterial and venous thrombosis in patients with and without hospitalization for COVID-19 and people who had not been diagnosed with COVID-19. A positive polymerase chain reaction (PCR) or antigen test or confirmed diagnosis from a primary or secondary care center was used to identify COVID-19 diagnoses.
Outcomes investigated 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 attack, intracerebral or subarachnoid hemorrhage and angina pectoris.
Hazard ratios were estimated comparing the incidence of vascular thrombotic events in individuals diagnosed with COVID-19 and individuals not diagnosed with COVID-19.
results
The results indicated a significant increase in the incidence of arterial thrombosis and venous thromboembolism in people diagnosed with COVID-19 compared to people without a diagnosis of COVID-19, 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 a diagnosis of COVID-19 who were hospitalized and not hospitalized within 28 days of diagnosis was 125,985 and 1,319,789 , respectively. The incidence of thrombotic events was higher and the decline in the number was slower in hospitalized COVID-19 patients than in non-hospitalized individuals.
Demographic factors such as age and gender did not appear to influence the incidence of thrombotic events. However, race appeared to be an important factor, as people of black and Asian ethnicities had higher incidences of thrombotic events than white people. The authors believe that the association of race with increased thrombotic events and higher rates of COVID-19-related mortality is influenced by factors such as employment, living conditions, deprivation, and living conditions. pre-existing health, among others.
In the follow-up of 41.6 million person-years in England, the number of first arterial thrombosis and venous thromboembolism was 260279 and 59421, respectively. Adjusted hazard ratios for comparisons of arterial thrombosis with and without COVID-19 diagnoses decreased from 21.7 to 1.34 from week 1 to weeks 27–49. Similarly, hazard ratios for venous thrombotic events decreased from 33.2 to 1.80 over the same duration.
In the entire population, there was a 0.5% increased risk of arterial thrombosis and a 0.25% increased risk of venous thromboembolism, which, in 1.4 million COVID-19 diagnoses, corresponds to to 7200 and 3500 cases of arterial and venous thrombotic events, respectively. .
Conclusions
Overall, the study reported a substantial increase in the incidence of arterial and venous thrombotic events in the weeks following COVID-19 diagnoses in England and Wales, with the numbers decreasing over time, although relatively slower for venous thromboembolism events.
The results highlight the need to use vaccines against COVID-19 to prevent severe manifestations of the disease requiring hospitalization, as the incidence of major thrombotic events was higher among patients with COVID-19 who were hospitalized than those who were not.
In addition, the authors believe that patients discharged after severe COVID-19, especially those with high-risk vascular disease, should receive secondary preventive therapies to reduce infection-associated thrombotic events and educate learn about the importance of reviews and follow-ups after discharge.
Given the rapidly evolving variants exhibiting immune evasion and emerging data on the various post-COVID-19 complications, there is a critical need for improved vaccines and therapies to reduce the severity of COVID-19, as well as new methods of treatment to reduce the infection. associated thrombotic events.
Journal 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, ED, Denaxas, S., Thygesen, JH, 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. Circulation doi: