Arterial Thrombotic Events in Adult Inpatients With COVID-19

Fournier, Morgane; Faille, Dorothée; Dossier, Antoine; Mageau, Arthur; Roland, Pascale Nicaise; Ajzenberg, Nadine; Borie, Raphael; Bouadma, Lila; Bunel, Vincent; Castier, Yves; Choquet, Christophe; Crestani, Bruno; Daugas, Eric; Deconinck, Laurene; Descamps, Diane; Descamps, Vincent; Dieudé, Philippe; Ducrocq, Gregory; Faucher, Nathalie; Goulenok, Tiphaine; Guidoux, Céline; Khalil, Antoine; Lavallée, Philippa; Lescure, François Xavier; Lortat-Jacob, Brice; Mal, Hervé; Mutuon, Pierre; Pellenc, Quentin; Steg, Philippe Gabriel; Taille, Camille; Timsit, Jean Francois; Yazdanpanah, Yazdan; Papo, Thomas; Sacré, Karim

Objective Coronavirus disease 2019 (COVID-19) infection triggers thrombotic events. We aimed to evaluate the clinical course and risk factors for arterial thrombotic events (AT) in adult inpatients with COVID-19. Patients and Methods All 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 AT that occurred through discharge were considered for analysis. Epidemiological, demographic, clinical, laboratory, treatment, and outcome data were extracted from electronic medical records using a standardized data collection form. Results Overall, 531 COVID-19+ patients were analyzed. Among them, 30 (5.6%) experienced AT events. AT 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%. AT increased the risk of death by 3 folds in COVID-19+ patients (HR 2.96 95%CI [1.4-4.7], P=.002). Subdistribution survival hazard model showed that a concentration of D-dimer >1250 ng/mL increased by >7 (sdHR 7.68 95%CI [2.9-20.6], P<.001) the risk of AT in COVID-19 + patients. Conclusion A dramatically high rate of in-hospital death was observed in patients who suffered AT in the setting of COVID-19 infection. A D-dimer level >1250 ng/mL at entry may identify COVID-19+ patients at risk for AT.