Comparison of Outcomes in Patients with COVID-19 and Thrombosis vs. Those Without Thrombosis: COVID-19 Patients with Thrombosis and Outcomes

Case, Brian C.; Abramowitz, Jonathan; Shea, Corey; Rappaport, Hank; Medranda, Giorgio A.; Yerasi, Charan; Forrestal, Brian J.; Chezar-Azerrad, Chava; Zhang, Cheng; Satler, Lowell F.; Ben-Dor, Itsik; Hashim, Hayder; Rogers, Toby; Weintraub, William S.; Waksman, Ron

Venous thromboembolism (VTE) in coronavirus disease 2019 (COVID-19) has been established. We sought to evaluate the clinical impact of thrombosis in COVID-19-positive patients over the span of the pandemic to date. We analyzed COVID-19-positive patients with the diagnosis of thrombosis who presented to the MedStar Health system (11 hospitals in Washington, DC, and Maryland) during the pandemic (March 1, 2020 – March 31, 2021). We compared clinical course and outcomes based on the presence or absence of thrombosis and then, specifically, cardiac thrombosis. The cohort included 11,537 COVID-19-positive admitted patients. Of these patients, 1,248 had non-cardiac thrombotic events and 1,009 had cardiac thrombosis (myocardial infarction) during their hospital admission. Of the non-cardiac thrombotic events, 562 (45.0%) were pulmonary embolism, 480 (38.5%) were deep venous thromboembolism, and 347 (27.8%) were stroke. In the thrombosis arm, the cohort's mean age was 64.5 ± 15.3 years, 53.3% were men, and a majority were African American (64.9%). Patients with thrombosis tended to be older, with more co-morbidities. In-hospital mortality was significantly higher (16.0%) in COVID-19-positive patients with concomitant thrombosis versus those without thrombosis (7.9%; p <0.001) but lower than in COVID-19-positive patients with cardiac thrombosis (24.7%; p <0.001). In conclusion, COVID-19 patients with thrombosis are at higher risk for in-hospital mortality. However, this prognosis is not as grim as cardiac thrombosis. Efforts should focus on early recognition, evaluation, and intensifying antithrombotic management of these patients.