Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales. Issue 12 (20th September 2022)

• Record Type: Journal Article
• Authors: Knight, Rochelle; Walker, Venexia; Ip, Samantha; Cooper, Jennifer A.; Bolton, Thomas; Keene, Spencer; Denholm, Rachel; Akbari, Ashley; Abbasizanjani, Hoda; Torabi, Fatemeh; Omigie, Efosa; Hollings, Sam; North, Teri-Louise; Toms, Renin; Jiang, Xiyun; Angelantonio, Emanuele Di; Denaxas, Spiros; Thygesen, Johan H.; Tomlinson, Christopher; Bray, Ben; Smith, Craig J.; Barber, Mark; Khunti, Kamlesh; Davey Smith, George; Chaturvedi, Nishi; Sudlow, Cathie; Whiteley, William N.; Wood, Angela M.; Sterne, Jonathan A.C.
• Is Part Of: Circulation. Volume 146:Issue 12(2022)
• Page Start: 892
• Page End: 906
• Publication Date: 2022-09-20
• Subjects: COVID-19 -- electronic health records -- myocardial infarction -- pulmonary embolism -- stroke -- thrombosis -- venous thrombosis; Blood -- Circulation -- Periodicals; Cardiovascular system -- Periodicals; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Blood Circulation; Cardiovascular System; Vascular Diseases; 616.1
• DOI: 10.1161/CIRCULATIONAHA.122.060785
• Languages: English
• ISSNs: 0009-7322

Abstract

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.