tetano
Editor, Senior Moderator
Circulation
. 2022 Sep 20;146(12):892-906.
doi: 10.1161/CIRCULATIONAHA.122.060785. Epub 2022 Sep 19.
Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales
Rochelle Knight[SUP] #[/SUP][SUP] 1 2 3 4 [/SUP], Venexia Walker[SUP] #[/SUP][SUP] 1 4 [/SUP], Samantha Ip[SUP] #[/SUP][SUP] 5 6 [/SUP], Jennifer A Cooper[SUP] 1 2 [/SUP], Thomas Bolton[SUP] 5 7 8 [/SUP], Spencer Keene[SUP] 5 7 [/SUP], Rachel Denholm[SUP] 1 2 9 [/SUP], Ashley Akbari[SUP] 10 [/SUP], Hoda Abbasizanjani[SUP] 10 [/SUP], Fatemeh Torabi[SUP] 10 [/SUP], Efosa Omigie[SUP] 11 [/SUP], Sam Hollings[SUP] 11 [/SUP], Teri-Louise North[SUP] 1 [/SUP], Renin Toms[SUP] 1 12 [/SUP], Xiyun Jiang[SUP] 5 [/SUP], Emanuele Di Angelantonio[SUP] 5 7 13 14 [/SUP], Spiros Denaxas[SUP] 15 16 17 18 [/SUP], Johan H Thygesen[SUP] 16 [/SUP], Christopher Tomlinson[SUP] 16 19 17 [/SUP], Ben Bray[SUP] 20 [/SUP], Craig J Smith[SUP] 21 22 [/SUP], Mark Barber[SUP] 23 [/SUP], Kamlesh Khunti[SUP] 24 [/SUP], George Davey Smith[SUP] 1 4 [/SUP], Nishi Chaturvedi[SUP] 25 [/SUP], Cathie Sudlow[SUP] 8 [/SUP], William N Whiteley[SUP] #[/SUP][SUP] 26 27 [/SUP], Angela M Wood[SUP] #[/SUP][SUP] 5 7 13 14 28 29 [/SUP], Jonathan A C Sterne[SUP] #[/SUP][SUP] 1 2 9 [/SUP], CVD-COVID-UK/COVID-IMPACT Consortium and the Longitudinal Health and Wellbeing COVID-19 National Core Study
Affiliations
Abstract
Background: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces a prothrombotic state, but long-term effects of COVID-19 on incidence of vascular diseases are unclear.
Methods: We studied vascular diseases after COVID-19 diagnosis in population-wide anonymized linked English and Welsh electronic health records from January 1 to December 7, 2020. We estimated adjusted hazard ratios comparing the incidence of arterial thromboses and venous thromboembolic events (VTEs) after diagnosis of COVID-19 with the incidence in people without a COVID-19 diagnosis. We conducted subgroup analyses by COVID-19 severity, demographic characteristics, and previous history.
Results: Among 48 million adults, 125 985 were hospitalized and 1 319 789 were not hospitalized within 28 days of COVID-19 diagnosis. In England, there were 260 279 first arterial thromboses and 59 421 first VTEs during 41.6 million person-years of follow-up. Adjusted hazard ratios for first arterial thrombosis after COVID-19 diagnosis compared with no COVID-19 diagnosis declined from 21.7 (95% CI, 21.0-22.4) in week 1 after COVID-19 diagnosis to 1.34 (95% CI, 1.21-1.48) during weeks 27 to 49. Adjusted hazard ratios for first VTE after COVID-19 diagnosis declined from 33.2 (95% CI, 31.3-35.2) in week 1 to 1.80 (95% CI, 1.50-2.17) during weeks 27 to 49. Adjusted hazard ratios were higher, for longer after diagnosis, after hospitalized versus nonhospitalized COVID-19, among Black or Asian versus White people, and among people without versus with a previous event. The estimated whole-population increases in risk of arterial thromboses and VTEs 49 weeks after COVID-19 diagnosis were 0.5% and 0.25%, respectively, corresponding to 7200 and 3500 additional events, respectively, after 1.4 million COVID-19 diagnoses.
Conclusions: High relative incidence of vascular events soon after COVID-19 diagnosis declines more rapidly for arterial thromboses than VTEs. However, incidence remains elevated up to 49 weeks after COVID-19 diagnosis. These results support policies to prevent severe COVID-19 by means of COVID-19 vaccines, early review after discharge, risk factor control, and use of secondary preventive agents in high-risk patients.
Keywords: COVID-19; electronic health records; myocardial infarction; pulmonary embolism; stroke; thrombosis; venous thrombosis.
. 2022 Sep 20;146(12):892-906.
doi: 10.1161/CIRCULATIONAHA.122.060785. Epub 2022 Sep 19.
Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales
Rochelle Knight[SUP] #[/SUP][SUP] 1 2 3 4 [/SUP], Venexia Walker[SUP] #[/SUP][SUP] 1 4 [/SUP], Samantha Ip[SUP] #[/SUP][SUP] 5 6 [/SUP], Jennifer A Cooper[SUP] 1 2 [/SUP], Thomas Bolton[SUP] 5 7 8 [/SUP], Spencer Keene[SUP] 5 7 [/SUP], Rachel Denholm[SUP] 1 2 9 [/SUP], Ashley Akbari[SUP] 10 [/SUP], Hoda Abbasizanjani[SUP] 10 [/SUP], Fatemeh Torabi[SUP] 10 [/SUP], Efosa Omigie[SUP] 11 [/SUP], Sam Hollings[SUP] 11 [/SUP], Teri-Louise North[SUP] 1 [/SUP], Renin Toms[SUP] 1 12 [/SUP], Xiyun Jiang[SUP] 5 [/SUP], Emanuele Di Angelantonio[SUP] 5 7 13 14 [/SUP], Spiros Denaxas[SUP] 15 16 17 18 [/SUP], Johan H Thygesen[SUP] 16 [/SUP], Christopher Tomlinson[SUP] 16 19 17 [/SUP], Ben Bray[SUP] 20 [/SUP], Craig J Smith[SUP] 21 22 [/SUP], Mark Barber[SUP] 23 [/SUP], Kamlesh Khunti[SUP] 24 [/SUP], George Davey Smith[SUP] 1 4 [/SUP], Nishi Chaturvedi[SUP] 25 [/SUP], Cathie Sudlow[SUP] 8 [/SUP], William N Whiteley[SUP] #[/SUP][SUP] 26 27 [/SUP], Angela M Wood[SUP] #[/SUP][SUP] 5 7 13 14 28 29 [/SUP], Jonathan A C Sterne[SUP] #[/SUP][SUP] 1 2 9 [/SUP], CVD-COVID-UK/COVID-IMPACT Consortium and the Longitudinal Health and Wellbeing COVID-19 National Core Study
Affiliations
- PMID: 36121907
- DOI: 10.1161/CIRCULATIONAHA.122.060785
Abstract
Background: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces a prothrombotic state, but long-term effects of COVID-19 on incidence of vascular diseases are unclear.
Methods: We studied vascular diseases after COVID-19 diagnosis in population-wide anonymized linked English and Welsh electronic health records from January 1 to December 7, 2020. We estimated adjusted hazard ratios comparing the incidence of arterial thromboses and venous thromboembolic events (VTEs) after diagnosis of COVID-19 with the incidence in people without a COVID-19 diagnosis. We conducted subgroup analyses by COVID-19 severity, demographic characteristics, and previous history.
Results: Among 48 million adults, 125 985 were hospitalized and 1 319 789 were not hospitalized within 28 days of COVID-19 diagnosis. In England, there were 260 279 first arterial thromboses and 59 421 first VTEs during 41.6 million person-years of follow-up. Adjusted hazard ratios for first arterial thrombosis after COVID-19 diagnosis compared with no COVID-19 diagnosis declined from 21.7 (95% CI, 21.0-22.4) in week 1 after COVID-19 diagnosis to 1.34 (95% CI, 1.21-1.48) during weeks 27 to 49. Adjusted hazard ratios for first VTE after COVID-19 diagnosis declined from 33.2 (95% CI, 31.3-35.2) in week 1 to 1.80 (95% CI, 1.50-2.17) during weeks 27 to 49. Adjusted hazard ratios were higher, for longer after diagnosis, after hospitalized versus nonhospitalized COVID-19, among Black or Asian versus White people, and among people without versus with a previous event. The estimated whole-population increases in risk of arterial thromboses and VTEs 49 weeks after COVID-19 diagnosis were 0.5% and 0.25%, respectively, corresponding to 7200 and 3500 additional events, respectively, after 1.4 million COVID-19 diagnoses.
Conclusions: High relative incidence of vascular events soon after COVID-19 diagnosis declines more rapidly for arterial thromboses than VTEs. However, incidence remains elevated up to 49 weeks after COVID-19 diagnosis. These results support policies to prevent severe COVID-19 by means of COVID-19 vaccines, early review after discharge, risk factor control, and use of secondary preventive agents in high-risk patients.
Keywords: COVID-19; electronic health records; myocardial infarction; pulmonary embolism; stroke; thrombosis; venous thrombosis.