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. 2021 Apr 8;5(3):412-420.
doi: 10.1002/rth2.12496. eCollection 2021 Mar.

Risk of thrombotic complications in influenza versus COVID-19 hospitalized patients

Milou A M Stals  1 , Marco J J H Grootenboers  2 , Coen van Guldener  3 , Fleur H J Kaptein  1 , Sander J E Braken  1 , Qingui Chen  4 , Gordon Chu  1 , Erik M van Driel  5 , Antonio Iglesias Del Sol  6 , Evert de Jonge  7 , K Merijn Kant  8 , Fleur Pals  1 , Myrthe M A Toorop  4 , Suzanne C Cannegieter  1   4 , Frederikus A Klok  1 , Menno V Huisman  1 ; Dutch COVID & Thrombosis Coalition (DCTC)
Affiliations

Risk of thrombotic complications in influenza versus COVID-19 hospitalized patients

Milou A M Stals et al. Res Pract Thromb Haemost. .

Abstract

Background: Whereas accumulating studies on patients with coronavirus disease 2019 (COVID-19) report high incidences of thrombotic complications, large studies on clinically relevant thrombosis in patients with other respiratory tract infections are lacking. How this high risk in COVID-19 patients compares to those observed in hospitalized patients with other viral pneumonias such as influenza is unknown.

Objectives: To assess the incidence of venous and arterial thrombotic complications in hospitalized patients with influenza as opposed to that observed in hospitalized patients with COVID-19.

Methods: This was a retrospective cohort study; we used data from Statistics Netherlands (study period: 2018) on thrombotic complications in hospitalized patients with influenza. In parallel, we assessed the cumulative incidence of thrombotic complications-adjusted for competing risk of death-in patients with COVID-19 in three Dutch hospitals (February 24 to April 26, 2020).

Results: Of the 13 217 hospitalized patients with influenza, 437 (3.3%) were diagnosed with thrombotic complications, versus 66 (11%) of the 579 hospitalized patients with COVID-19. The 30-day cumulative incidence of any thrombotic complication in influenza was 11% (95% confidence interval [CI], 9.4-12) versus 25% (95% CI, 18-32) in COVID-19. For venous thrombotic (VTC) complications and arterial thrombotic complications alone, these numbers were, respectively, 3.6% (95% CI, 2.7-4.6) and 7.5% (95% CI, 6.3-8.8) in influenza versus 23% (95% CI, 16-29) and 4.4% (95% CI, 1.9-8.8) in COVID-19.

Conclusions: The incidence of thrombotic complications in hospitalized patients with influenza was lower than in hospitalized patients with COVID-19. This difference was mainly driven by a high risk of VTC complications in the patients with COVID-19 admitted to the Intensive Care Unit. Remarkably, patients with influenza were more often diagnosed with arterial thrombotic complications.

Keywords: COVID‐19; human; incidence; influenza; pneumonia; thrombosis; viral.

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