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. 2021 Feb;96(2):295-303.
doi: 10.1016/j.mayocp.2020.11.018. Epub 2020 Nov 27.

Arterial Thrombotic Events in Adult Inpatients With COVID-19

Morgane Fournier  1 , Dorothée Faille  2 , Antoine Dossier  1 , Arthur Mageau  1 , Pascale Nicaise Roland  3 , Nadine Ajzenberg  2 , Raphael Borie  4 , Lila Bouadma  5 , Vincent Bunel  6 , Yves Castier  7 , Christophe Choquet  8 , Bruno Crestani  4 , Eric Daugas  9 , Laurene Deconinck  10 , Diane Descamps  11 , Vincent Descamps  12 , Philippe Dieudé  13 , Gregory Ducrocq  14 , Nathalie Faucher  15 , Tiphaine Goulenok  1 , Céline Guidoux  16 , Antoine Khalil  17 , Philippa Lavallée  16 , François Xavier Lescure  10 , Brice Lortat-Jacob  18 , Hervé Mal  6 , Pierre Mutuon  19 , Quentin Pellenc  7 , Philippe Gabriel Steg  14 , Camille Taille  4 , Jean Francois Timsit  5 , Yazdan Yazdanpanah  10 , Thomas Papo  20 , Karim Sacré  21
Affiliations

Arterial Thrombotic Events in Adult Inpatients With COVID-19

Morgane Fournier et al. Mayo Clin Proc. 2021 Feb.

Abstract

Objective: To evaluate the clinical course of and risk factors for arterial thrombotic events in adult inpatients with coronavirus disease 2019 (COVID-19).

Methods: All consecutive adult patients admitted for COVID-19 infection in a referral center in France and discharged from the hospital between April 1 and April 30, 2020, were included. All arterial thrombotic events that occurred through discharge were considered for analysis. Epidemiologic, demographic, clinical, laboratory, treatment, and outcome data were extracted from electronic medical records with use of a standardized data collection form.

Results: Overall, 531 COVID-19+ patients were analyzed. Among them, 30 (5.6%) experienced arterial thrombotic events. Arterial thrombotic events in the setting of COVID-19 infection happened at a median of 11 (5-20) days after the first symptoms of infection; occurred in high-risk patients according to traditional cardiovascular risk factors; had an atypical pattern, such as thrombosis of the aorta, upper limb, or renal arteries or cerebral microvasculopathy in 7 (23.3%) cases; and were associated with an in-hospital mortality rate of 40%. Arterial thrombotic events increased the risk of death by 3-fold in COVID-19+ patients (hazard ratio, 2.96; 95% CI, 1.4 to 4.7; P=.002). A subdistribution survival hazard model showed that a concentration of D-dimer above 1250 ng/mL increased the risk of arterial thrombotic events in COVID-19+ patients by more than 7 (subdistribution hazard ratio, 7.68; 95% CI, 2.9 to 20.6; P<.001).

Conclusion: A dramatically high rate of in-hospital death was observed in patients who suffered arterial thrombotic events in the setting of COVID-19 infection. A D-dimer level above 1250 ng/mL at entry may identify COVID-19+ patients at risk for arterial thrombotic events.

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Figures

Figure 1
Figure 1
Overall survival in COVID-19+ patients according to arterial thrombotic event (AT) status. Kaplan-Meier curves represent survival without in-hospital death according to AT status. Time 0 was the day of admission. Follow-up ended at discharge. The solid line represents the outcome in patients without AT (AT−). The dashed lines represent the outcomes in patients with AT (AT+). Analysis was performed on 531 patients.
Figure 2
Figure 2
Survival without arterial thrombotic events in COVID-19+ patients according to D-dimer level measured in plasma at baseline. Kaplan-Meier curves represent the survival without an arterial thrombotic event according to D-dimer level (>1250 or <1250 ng/mL) measured in plasma early after admission. Time 0 was the day of admission. Follow-up ended at discharge. The solid line represents the outcome in patients with D-dimer level below 1250 ng/mL. The dashed lines represent the outcomes in patients with D-dimer level above 1250 ng/mL. D-dimer values were obtained 1 (0-3) day after admission and 2 (1-14) days before onset of an arterial thrombotic event and were available for analysis in 318 patients. The reference concentration of D-dimer at our institution is less than 234 ng/mL.
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