Background
Little is known about the arterial complications and hypercoagulability associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We sought to characterize our experience with arterial thromboembolic complications in patients with hospitalized for coronavirus disease 2019 (COVID-19).
Methods
All patients admitted from March 1 to April 20, 2020, and who underwent carotid, upper, lower and aortoiliac arterial duplex, computed tomography angiogram or magnetic resonance angiography for suspected arterial thrombosis were included. A retrospective case control study design was used to identify, characterize and evaluate potential risk factors for arterial thromboembolic disease in SARS-CoV-2 positive patients. Demographics, characteristics, and laboratory values were abstracted and analyzed.
Results
During the study period, 424 patients underwent 499 arterial duplex, computed tomography angiogram, or magnetic resonance angiography imaging studies with an overall 9.4% positive rate for arterial thromboembolism. Of the 40 patients with arterial thromboembolism, 25 (62.5%) were SARS-CoV-2 negative or admitted for unrelated reasons and 15 (37.5%) were SARS-CoV-2 positive. The odds ratio for arterial thrombosis in COVID-19 was 3.37 (95% confidence interval, 1.68-6.78;
P
= .001). Although not statistically significant, in patients with arterial thromboembolism, patients who were SARS-CoV-2 positive compared with those testing negative or not tested tended to be male (66.7% vs 40.0%;
P
= .191), have a less frequent history of former or active smoking (42.9% vs 68.0%;
P
= .233) and have a higher white blood cell count (14.5 vs 9.9;
P
= .208). Although the SARS-CoV-2 positive patients trended toward a higher the neutrophil-to-lymphocyte ratio (8.9 vs 4.1;
P
= .134), creatinine phosphokinase level (359.0 vs 144.5;
P
= .667), C-reactive protein level (24.2 vs 13.8;
P
= .627), lactate dehydrogenase level (576.5 vs 338.0;
P
= .313), and ferritin level (974.0 vs 412.0;
P
= .47), these differences did not reach statistical significance. Patients with arterial thromboembolic complications and SARS-CoV-2 positive when compared with SARS-CoV-2 negative or admitted for unrelated reasons were younger (64 vs 70 years;
P
= .027), had a significantly higher body mass index (32.6 vs 25.5;
P
= .012), a higher
d
-dimer at the time of imaging (17.3 vs 1.8;
P
= .038), a higher average in hospital
d
-dimer (8.5 vs 2.0;
P
= .038), a greater distribution of patients with clot in the aortoiliac location (5 vs 1;
P
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