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, 2115 COVID-19 patients were treated at Hospital Universitario Fundación Alcorcón (Madrid, Spain), and 1419 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. Keywords Thrombosis • Acute coronary syndrome • Stroke • Peripheral arterial disease • COVID-19 Highlights • Evidence of thrombosis is a common finding in severe COVID-19 patients. • There is very little data on the incidence and consequences of coronary, cerebrovascular and peripheral vascular thrombotic events. • In a large cohort of 1419 COVID-19 patients we observed a 1% incidence of systemic arterial thrombotic events, with a death rate of 28.6%. • Although SARS-CoV2 infection may favor arterial thrombotic events, with grave consequences, it does not seem to be a frequent enough phenomena to warrant the need for specific systematic preventive measures.

Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic

“…Ischemic Stroke 37 Articles [39], [57], [58], [60], [63], [73], [74], [75], [76] [77], [78], [79], [80],. [81], [82], [83], [84], [85], [86], [87], [88], [89], [90], [91], [92], [93], [94], [95], [96], [97], [98], [99], [100], [101], [102], [178], [192] 363 NR in all articles.…”

SARS-CoV-2 and nervous system: From pathogenesis to clinical manifestation

“…A thrombotic event was sometimes reported as the first presentation of COVID-19 infection ( Hughes et al, 2020 ; Klok et al, 2020 ). In a retrospective study on 214 COVID-19 patients, about 6% presented with acute cerebrovascular events, mainly ischemic strokes ( Cantador et al, 2020 ). A small number of stroke patients with COVID-19 infection presented with cerebral hemorrhage ( Cantador et al, 2020 ).…”

“…In a retrospective study on 214 COVID-19 patients, about 6% presented with acute cerebrovascular events, mainly ischemic strokes ( Cantador et al, 2020 ). A small number of stroke patients with COVID-19 infection presented with cerebral hemorrhage ( Cantador et al, 2020 ). Recent investigation has also found that COVID-19 patients have increased serum Nox2 overactivation, which is an important trigger for vascular dysfunction through excess production of reactive oxygen species ( Violi et al, 2020a ).…”

Acute Upper Limb Ischemia Due To Arterial Thrombosis in a Mild COVID-19 Patient: A Case Report

“…Cantador et al, in a retrospective observational study, demonstrated that out of 1419 COVID-19 patients, 14 (1%) patients developed systemic arterial thrombotic events of acute coronary syndrome, acute ischemic stroke, and acute lower limb ischemia with a mortality rate of 28.6% in these patients [10]. Similarly, a recent observational cohort study from Italy illustrated an increase in the incidence of acute limb ischemia in patients with COVID-19 from January to March 2020 compared to January to March 2019 (16.3% vs. 1.8%, respectively; p<.001) [11].…”