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Thrombosis in Hospitalized Patients With COVID-19 in a New York City Health System

Educational Objective
To understand the risks of thrombosis in hospitalized patients with COVID-19
1 Credit CME

Patients with coronavirus disease 2019 (COVID-19) are at increased risk of thrombosis.1 However, studies have been limited in size, did not report all thrombotic events, and focused on patients with severe disease hospitalized in intensive care units (ICUs). We assessed the incidence of, and risk factors for, venous and arterial thrombotic events in all hospitalized patients with COVID-19 at a large health system consisting of 4 hospitals in New York City.

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Article Information

Corresponding Author: Jeffrey S. Berger, MD, MS, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, 530 First Ave, Skirball 9R, New York, NY 10016 (jeffrey.berger@nyulangone.org).

Accepted for Publication: July 8, 2020.

Published Online: July 20, 2020. doi:10.1001/jama.2020.13372

Correction: This article was corrected on July 29, 2020, to fix the hazard ratios for male sex and current smoker in Table 2.

Author Contributions: Dr Berger had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Bilaloglu, Iturrate, Hochman, Berger.

Acquisition, analysis, or interpretation of data: Bilaloglu, Aphinyanaphongs, Jones, Iturrate.

Drafting of the manuscript: Bilaloglu, Iturrate, Berger.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Bilaloglu, Jones.

Administrative, technical, or material support: Bilaloglu, Iturrate, Berger.

Supervision: All authors.

Conflict of Interest Disclosures: Dr Hochman reported receiving support for drug distribution related to the ISCHEMIA Trial and in-kind donations for participating sites from AstraZeneca Pharmaceuticals and Arbor Pharmaceuticals; in-kind donations for participating sites from Abbott Vascular, Medtronic Inc, St Jude Medical Inc, Volcano Corp, Merck Sharp & Dohme Corp, Omron Healthcare Inc, and Amgen Inc; and grants from the National Heart, Lung, and Blood Institute for serving as chair of the ISCHEMIA study. Dr Berger reported receiving grants from AstraZeneca, personal fees from Janssen, and personal fees from Amgen outside the submitted work. No other disclosures were reported.

Funding/Support: Funding for this project was supported in part by New York University (NYU) CTSA grant UL1TR001445 from the National Center for Advancing Translational Sciences. Dr Berger is funded in part by the National Heart, Lung, and Blood Institute (grants R01HL139909 and R35HL144993).

Role of the Funder/Sponsor: The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We acknowledge Meng Cao, BSE, Siddhant Dogra, BS, Ruina Zhang, AB, and Emma Simon, BS, who reviewed the clinical charts, and Ji Chen, MS, who queried data, all from the NYU Grossman School of Medicine. There was no financial compensation for these contributions.

References
1.
Connors  JM , Levy  JH .  COVID-19 and its implications for thrombosis and anticoagulation.   Blood. 2020;135(23):2033-2040. doi:10.1182/blood.2020006000PubMedGoogle ScholarCrossref
2.
Swartz  J , Koziatek  C , Theobald  J , Smith  S , Iturrate  E .  Creation of a simple natural language processing tool to support an imaging utilization quality dashboard.   Int J Med Inform. 2017;101:93-99. doi:10.1016/j.ijmedinf.2017.02.011PubMedGoogle ScholarCrossref
3.
Cui  S , Chen  S , Li  X , Liu  S , Wang  F .  Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia.   J Thromb Haemost. 2020;18(6):1421-1424. doi:10.1111/jth.14830 PubMedGoogle ScholarCrossref
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Klok  FA , Kruip  MJHA , van der Meer  NJM ,  et al.  Incidence of thrombotic complications in critically ill ICU patients with COVID-19.   Thromb Res. 2020;191:145-147. doi:10.1016/j.thromres.2020.04.013PubMedGoogle ScholarCrossref
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Grimnes  G , Isaksen  T , Tichelaar  YIGV , Brækkan  SK , Hansen  JB .  Acute infection as a trigger for incident venous thromboembolism: results from a population-based case-crossover study.   Res Pract Thromb Haemost. 2017;2(1):85-92. doi:10.1002/rth2.12065PubMedGoogle ScholarCrossref
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Bunce  PE , High  SM , Nadjafi  M , Stanley  K , Liles  WC , Christian  MD .  Pandemic H1N1 influenza infection and vascular thrombosis.   Clin Infect Dis. 2011;52(2):e14-e17. doi:10.1093/cid/ciq125PubMedGoogle ScholarCrossref
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