Characterization of risk factors and location of Covid19 arterial thromboembolic events
Christopher Ryan Bates, Dawn Blackhurst, Rachel Westphal, Sagar Gandhi
Prisma Health- USC SOM-Greenville SC, Greenville, SC
INTRODUCTION: During the Covid19 pandemic, numerous reports have been published that suggest increased arterial thromboembolic events from a presumed hypercoagulable state. However, the vessels most affected, and patient risk factors leading to these events have not been well characterized.
METHODS: A retrospective study using hospitalized patient data, from large multi-hospital healthcare system. We queried 4,882 unique patients admitted with Covid19 from March 1, 2020, through December 31, 2021. Patient age was restricted to 30-95 years of age. Each patient who carried coexistent diagnosis of Covid19 and thromboembolic event, underwent chart review to characterize the type of event (stroke, mesenteric ischemia, peripheral arterial occlusion) and the location of the thromboembolic event. We then compared the hospitalized Covid19 patients without diagnosis of arterial thromboembolism during their admission with the patients who developed arterial thromboembolism. Patient demographic, comorbidities, and clinical characteristics were then evaluated using bivariate analysis: data are presented as Mean ± Standard Deviation or Number (%). P-values from Chi-square test for categorical data or Student’s t-test for continuous data. Multivariable logistic regression analysis for predictors of Covid19 thromboembolic events was performed.
RESULTS: The three most common thromboembolic sites in Covid19 thromboembolic events were intracranial (43.4%), carotid (7.2%) and popliteal (4.3%). The most common peripheral vessels involved were the popliteal (4.3%), tibial (3.6%) and iliac (2.9%). When controlling for patient age, patient’s with Covid19 arterial thromboembolism had a significantly greater D-dimer (5.30, p<0.001), were active smokers (21 (15.6), p<0.039), were more likely to have a history of peripheral arterial disease (7 (5.1), p<0.001), TIA (10 (7.3), p<0.003), or cardiac dysrhythmia (49 (35.5), p<0.001). These patients also had higher hospital length of stay (11.9 ± 13.4, p<0.001) and mortality (40 (29.0), p<0.002). Multivariable logistic regression analysis was performed and demonstrated a history of PAD (3.97, p<0.017) was the strongest predictor of developing covid arterial thromboembolic events. This was followed by history of TIA (2.58, p<0.034) and cardiac dysrhythmia (2.08, p<0.001). Unexpectedly, obesity (BMI>25) (0.36, p<0.002) was found to be protective against Covid19 arterial thromboembolic events.
CONCLUSIONS:The most common site of arterial thromboembolic events resulted in stroke, primarily affecting the intracranial and carotid arteries. The most common site of peripheral thromboembolic events were the popliteal and tibial arteries. Major risk factors include prior history of PAD, TIA and cardiac dysrhythmias. Taken together, this data helps further characterize the arterial thromboembolic events prominent in hospitalized Covid19 patients and additional research should be conducted to elucidate prevention strategies to limit these events during future pandemics.
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