Incidence and consequences of systemic arterial thrombotic events in COVID-19 patients

Abstract

A high incidence of thrombotic events, particularly deep vein thrombosis and pulmonary embolism, has been clearly documented in COVID-19 patients. In addition, small series of patients with coronary, cerebrovascular and peripheral arterial thrombotic events have also been reported, but their true incidence and consequences are not well described, and constitute the objective of this study. From February 1st to April 21st, 2020, 2,115 COVID-19 patients were treated at Hospital Universitario Fundación Alcorcón (Madrid, Spain), and 1,419 were eventually admitted. Patient characteristics and outcomes were collected by reviewing their electronic medical records. Fourteen patients had a systemic arterial thrombotic event, which represents a 1% incidence in relation to the total number of hospitalized patients. Three patients suffered an acute coronary syndrome, two with persistent ST-segment elevation, one of whom was treated invasively, and one with transient ST-segment elevation. Eight patients had a cerebrovascular event. Six suffered an acute ischemic stroke and two a transient ischemic attack, 50% of them had a Rankin score ≥3 at discharge. Three additional patients had a limb thrombotic event, all of them infrapopliteal, and were managed conservatively. All three cases developed necrosis of the toes, two of them with bilateral involvement. The hospitalization death rate of patients with an arterial event was 28.6%. Although COVID-19 may favor the occurrence of thrombotic events, the destabilization and thrombosis of arterial atherosclerotic plaques do not seem to be a frequent mechanism which warrants the need for specific systematic preventive measures.

Acute Limb Ischemia in a Peruvian Cohort Infected by COVID-19

“…41 The mortality rate in our series was 23.3%, similar to other studies with mortality rates between 23-40%. 6,14,36,42,43 The average age of the deceased was years, corresponding to the age group most affected in our population. 44 It is expected that adults over 80 years of age are the main affected group, with a higher rate in men in whom hypercoagulable states predominate.…”

“…44 It is expected that adults over 80 years of age are the main affected group, with a higher rate in men in whom hypercoagulable states predominate. 6,42,43,45 Thromboembolic phenomena and mortality correlate with the severity of the infection. 6,14,35 In all the patients who died, they had greater clinical severity of COVID-19 infection, and mortality was attributed to ARDS.…”

Stroke as a Neurological Complication of COVID-19: A Systematic Review and Meta-Analysis of Incidence, Outcomes and Predictors

“…After screening of titles and abstracts, 81 publications were reviewed in full text. A total of 30 original studies 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 were eventually included in our systematic review with a combined population of 55,176 patients, including 899 who experienced a stroke [ Table 1 ]. Reliability of study selection between observers was substantial at both the title and abstract screening stage (Cohen's κ = 0.93) and the full-text review stage (Cohen's κ = 1.00).…”

The Impact of SARS‐CoV‐2 on Stroke Epidemiology and Care: A Meta‐Analysis

“…Finally, we identified 18 observational cohort studies including a total of 67,845 patients who qualified our predefined inclusion and exclusion criteria (Supplementary Table S3). 18–35 Nine of the included studies reported imaging confirmation of reported cerebrovascular events 21–24,26,27,33–35 …”

“…However, cohorts of certain studies were judged not to be truly representative of community patients suffering from COVID‐19, as they included only specific patient subpopulations: patients less than 50 years of age, 18 patients with acute respiratory distress syndrome, 22 patients admitted to the ICU, 22,25 patients infected with SARS‐CoV‐2 who had neurological manifestations and had undergone magnetic resonance imaging investigation, 26 or patients with acute ischemic stroke attributed to a large vessel occlusion 21 . In addition, description of the derivation of the nonexposed cohort was not applicable for 5 studies without controls 20,23,25,26,32 . Comparability was considered satisfactory in most of the included studies, with the exception of the aforementioned 5 studies that included no control groups 20,23,25,26,32 .…”