Arterial Thrombotic Events in Hospitalized COVID-19 Patients: A Short Review and Meta-Analysis

Abstract

It is well established that the risk of venous thromboembolism is high in coronavirus disease 19 (COVID-19). The frequency of arterial thromboembolic events (ATEs) in hospitalized patients with COVID-19 is unclear, as is the magnitude of these events in comparison with other infections. We searched MEDLINE from February 2020 to February 2022 for prospective or retrospective cohort studies and randomized clinical trials that reported the number of acute myocardial infarction (AMI), acute ischemic stroke (AIS), acute limb ischemia (ALI), or other ATE as defined by the original authors in hospitalized patients with COVID-19. The pooled frequencies were calculated through meta-analysis using random effects model with logit transformation and presented with relative 95% prediction intervals (95% PI). We retrieved a total of 4,547 studies, 36 of which (28 retrospective cohorts, five prospective cohorts and three randomized trials) were finally included in our analysis. The resulting cohort counted 100,949 patients, 2,641 (2.6%) of whom experienced ATE. The pooled ATE frequency was 2.0% (95% PI, 0.4–9.6%). The pooled ATE frequency for AMI, AIS, ALI, and other ATE was 0.8% (95% PI, 0.1–8.1%), 0.9% (95% PI, 0.3–2.9%), 0.2% (95% PI, 0.0–4.2%), and 0.5% (95% PI, 0.1–3.0%), respectively. In comparison with the ATE incidence reported in three studies on non-COVID viral pneumonia, we did not detect a significant difference from the results in our analysis. In conclusion, we found a non-negligible proportion of ATE in patients hospitalized for COVID-19. Our results are similar to those found in hospitalized patients with influenza or with non-COVID viral pneumonia.

Impact of the COVID‐19 pandemic on acute stroke care: An analysis of the 24‐month data from a comprehensive stroke center in Shanghai, China

“…Growing evidence indicates a nonnegligible prevalence of neurological involvement during COVID‐19 infection or postinfection period, including seizures, encephalopathy, acute ischemic stroke, etc 14–17 . The systematic review of 100,949 patients with COVID‐19 from the early phase of the pandemic to the omicron waves reported a pooled incidence of acute ischemic stroke in patients hospitalized for COVID‐19 of 0.9% 18 . Though the frequency seems low, concomitant COVID‐19 infection and stroke might result in poor outcomes despite aggressive medical treatment, suggesting an urgency for timely diagnosis and emergency treatment of COVID‐19‐associated stroke 16 .…”

“…[14][15][16][17] The systematic review of 100,949 patients with COVID-19 from the early phase of the pandemic to the omicron waves reported a pooled incidence of acute ischemic stroke in patients hospitalized for COVID-19 of 0.9%. 18 stroke. 16 Paradoxically, there was a global decline in new stroke admissions and reperfusion therapies at the height of the pandemic.…”

Has “D-dimeritis” worsened during the COVID-19 pandemic?

“…2 An increased risk of developing acute thrombotic evens, both venous and arterial, is a hallmark of severe/critical COVID-19 cases, as comprehensively described elsewhere. [3][4][5] Thus, D-dimer values are very frequently elevated in patients with SARS-CoV-2 infection, correlate with the clinical phenotype, and predict the risk of developing thrombosis and multiple organ failure. 6,7 It is hence not surprising that the number of D-dimer test requests may have undergone a paramount increase throughout the COVID-19 pandemic, whereby the value of this biomarker may provide a valuable, almost unreplaceable contribution to the diagnostic approach, clinical decision making, risk stratification and managed care of patients with COVID-19.…”

Has “D-Dimeritis” Worsened during the Coronavirus Disease 2019 Pandemic?

“…2 An increased risk of developing acute thrombotic events, both venous and arterial, is a hallmark of severe/critical COVID-19 cases, as comprehensively described elsewhere. [3][4][5] Thus, D-dimer values are very frequently elevated in patients with acute SARS-CoV-2 infection, correlate with the clinical phenotype, and predict the risk of developing thrombosis and multiple organ failure. 6,7 It is therefore not surprising that the number of D-dimer test requests may have undergone a paramount increase throughout the COVID-19 pandemic, whereby the value of this biomarker may provide a valuable, almost unreplaceable contribution to the diagnostic approach, clinical decision-making, risk stratification, and managed care of patients with COVID-19.…”