• Mayo Clinic proceedings · Feb 2021

    Arterial Thrombotic Events in Adult Inpatients With COVID-19.

    • Morgane Fournier, Dorothée Faille, Antoine Dossier, Arthur Mageau, Nicaise Roland Pascale P Département d'Immunologie, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France; INSERM UMR 1152, Paris, France., Nadine Ajzenberg, Raphael Borie, Lila Bouadma, Vincent Bunel, Yves Castier, Christophe Choquet, Bruno Crestani, Eric Daugas, Laurene Deconinck, Diane Descamps, Vincent Descamps, Philippe Dieudé, Gregory Ducrocq, Nathalie Faucher, Tiphaine Goulenok, Céline Guidoux, Antoine Khalil, Philippa Lavallée, François Xavier Lescure, Brice Lortat-Jacob, Hervé Mal, Pierre Mutuon, Quentin Pellenc, Philippe Gabriel Steg, Camille Taille, Jean Francois Timsit, Yazdan Yazdanpanah, Thomas Papo, and Karim Sacré.
    • Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Université de Paris, France.
    • Mayo Clin. Proc. 2021 Feb 1; 96 (2): 295-303.

    ObjectiveTo evaluate the clinical course of and risk factors for arterial thrombotic events in adult inpatients with coronavirus disease 2019 (COVID-19).MethodsAll 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.ResultsOverall, 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).ConclusionA 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.Copyright © 2020 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

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