COVID-19 and Risk of VTE in Ethnically Diverse Populations

Go, Alan S.; Reynolds, Kristi; Tabada, Grace H.; Prasad, Priya; Sung, Sue Hee; Garcia, Elisha; Portugal, Cecilia; Fan, Dongjie; Pai, Ashok; Fang, Margaret C.

doi:10.1016/j.chest.2021.07.025

Cited by 18 publications

(17 citation statements)

References 34 publications

(30 reference statements)

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“…OVID-19 infection can be followed by multiorgan pathology, including vascular damage involving the venous and arterial systems. [1][2][3] Optical coherence tomography angiography [4][5][6][7] studies have found reductions in retinal vascular density in patients with COVID-19 infection compared with controls. An association between COVID-19 and retinal vascular occlusions seems intuitive given the prothrombotic state induced by this infection and the retinal vascular alterations that have been observed; however, data on a possible association are limited.…”

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confidence: 99%

Changes in the Incidence of Retinal Vascular Occlusions After COVID-19 Diagnosis

Modjtahedi

Do²,

Luong³

et al. 2022

JAMA Ophthalmol

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IMPORTANCE COVID-19 is associated with systemic vascular damage; however, the risk posed to the retinal vasculature remains incompletely understood. OBJECTIVE To assess if there is a change in the incidence of retinal vascular occlusions after COVID-19 infection. DESIGN, SETTING, AND PARTICIPANTS This cohort study at an integrated health care organization (Kaiser Permanente Southern California) included patients without a history of retinal vascular occlusion who were diagnosed with COVID-19 infection between January 20, 2020, and May 31, 2021. Patients were excluded if they had a history of retinal artery occlusions (RAOs) or retinal vein occlusions (RVOs) more than 6 months before their COVID-19 diagnosis or if they were enrolled in Kaiser Permanente Southern California for less than 6 months before COVID-19 diagnosis. EXPOSURES COVID-19 infection. MAIN OUTCOMES AND MEASURESThe change in the average biweekly incidence of new RAOs and RVOs after COVID-19 diagnosis. Adjusted incidence rate ratios (IRRs) were calculated to compare the incidence of retinal vascular occlusions before and after COVID-19 diagnosis after accounting for baseline demographic characteristics, medical history, and hospitalization.RESULTS A total of 432 515 patients diagnosed with COVID-19 infection were included in this study. The mean (SD) age was 40.9 (19.2) years, and 231 767 patients (53.6%) were women. Sixteen patients had an RAO (crude incidence rate, 3.00 per 1 000 000 patients), and 65 had an RVO (crude incidence rate, 12.20 per 1 000 000 patients) in the 6 months after COVID-19 diagnosis. The incidence of new RVOs was higher in the 6 months after COVID-19 infection compared with the 6 months before infection after adjusting for age; sex; self-reported race and ethnicity; body mass index; history of diabetes, hypertension, or hyperlipidemia; and hospitalization (adjusted IRR, 1.54; 95% CI, 1.05-2.26; P = .03). There was a smaller increase in the incidence of RAOs after COVID-19 diagnosis (IRR, 1.35; 95% CI, 0.64-2.85; P = .44). The peak incidence of RAOs and RVOs occurred 10 to 12 weeks and 6 to 8 weeks after COVID-19 diagnosis, respectively. CONCLUSIONS AND RELEVANCEThe findings of this study suggest that there was an increase in the incidence of RVOs after COVID-19 infection; however, these events remain rare, and in the absence of randomized controls, a cause-and-effect relationship cannot be established. Further large, epidemiologic studies are warranted to better define the association between retinal thromboembolic events and COVID-19 infection.

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mentioning

confidence: 99%

Changes in the Incidence of Retinal Vascular Occlusions After COVID-19 Diagnosis

Modjtahedi

Do²,

Luong³

et al. 2022

JAMA Ophthalmol

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“…By comparison, the rate was found to be 3.1 per 1000 discharges in 2019, which occurred within 42 days of discharge. The odds ratio of HA-VTE associated with COVID-19 compared with rates observed in 2019 before COVID-19 was 1.6 (95% CI, 0.8–3.1) and was not statistically significant [36] .…”

Section: Discussionmentioning

confidence: 69%

Cardiovascular complications in the Post-Acute COVID-19 syndrome (PACS)

Elseidy

Awad

Vorla

et al. 2022

IJC Heart & Vasculature

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“…5,6 Factors that increase VTE risk in COVID-19 infection include disease severity, male sex, older age, history of VTE, and obesity. 7 A meta-analysis of 66 observational studies reported higher VTE prevalence in hospitalized patients admitted to the intensive care unit (ICU) and in those screened with ultrasound. 8 In surgical patients, Doglietto et al 9…”

Section: Introductionmentioning

confidence: 99%

“…Since the start of the coronavirus disease 2019 (COVID‐19) pandemic, clinicians have recognized that VTE is a significant complication of COVID‐19 infection 5,6 . Factors that increase VTE risk in COVID‐19 infection include disease severity, male sex, older age, history of VTE, and obesity 7 . A meta‐analysis of 66 observational studies reported higher VTE prevalence in hospitalized patients admitted to the intensive care unit (ICU) and in those screened with ultrasound 8 .…”

Section: Introductionmentioning

confidence: 99%

“… 5 , 6 Factors that increase VTE risk in COVID‐19 infection include disease severity, male sex, older age, history of VTE, and obesity. 7 A meta‐analysis of 66 observational studies reported higher VTE prevalence in hospitalized patients admitted to the intensive care unit (ICU) and in those screened with ultrasound. 8 In surgical patients, Doglietto et al 9 and COVIDSurg Collaborative and GlobalSurg Collaborative 10 demonstrated a higher risk of mortality and higher odds of thrombotic complications for patients with COVID‐19 infection compared to non‐COVID‐19 patients.…”

Section: Introductionmentioning

confidence: 99%

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The association of acute COVID‐19 infection with Patient Safety Indicator‐12 events in a multisite healthcare system

Bhakta

Pollock

Erben

et al. 2022

Journal of Hospital Medicine

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Background Patient Safety Indicator (PSI)‐12, a hospital quality measure designed by Agency for Healthcare Research and Quality (AHRQ) to capture potentially preventable adverse events, captures perioperative venous thromboembolism (VTE). It is unclear how COVID‐19 has affected PSI‐12 performance. Objective We sought to compare the cumulative incidence of PSI‐12 in patients with and without acute COVID‐19 infection. Design, Setting, and Participants This was a retrospective cohort study including PSI‐12‐eligible events at three Mayo Clinic medical centers (4/1/2020‐10/5/2021). Exposure, Main Outcomes, and Measures We compared the unadjusted rate and adjusted risk ratio (aRR) for PSI‐12 events among patients with and without COVID‐19 infection using Fisher's exact χ2 test and the AHRQ risk‐adjustment software, respectively. We summarized the clinical outcomes of COVID‐19 patients with a PSI‐12 event. Results Our cohort included 50,400 consecutive hospitalizations. Rates of PSI‐12 events were significantly higher among patients with acute COVID‐19 infection (8/257 [3.11%; 95% confidence interval {CI}, 1.35%–6.04%]) compared to patients without COVID‐19 (210/50,143 [0.42%; 95% CI, 0.36%–0.48%]) with a PSI‐12 event during the encounter (p < .001). The risk‐adjusted rate of PSI‐12 was significantly higher in patients with acute COVID‐19 infection (1.50% vs. 0.38%; aRR, 3.90; 95% CI, 2.12–7.17; p < .001). All COVID‐19 patients with PSI‐12 events had severe disease and 4 died. The most common procedure was tracheostomy (75%); the mean (SD) days from surgical procedure to VTE were 0.12 (7.32) days. Conclusion Patients with acute COVID‐19 infection are at higher risk for PSI‐12. The present definition of PSI‐12 does not account for COVID‐19. This may impact hospitals' quality performance if COVID‐19 infection is not accounted for by exclusion or risk adjustment.

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COVID-19 and Risk of VTE in Ethnically Diverse Populations

Cited by 18 publications

References 34 publications

Changes in the Incidence of Retinal Vascular Occlusions After COVID-19 Diagnosis

Changes in the Incidence of Retinal Vascular Occlusions After COVID-19 Diagnosis

Cardiovascular complications in the Post-Acute COVID-19 syndrome (PACS)

The association of acute COVID‐19 infection with Patient Safety Indicator‐12 events in a multisite healthcare system

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