04 Nov Natural coagulopathy and characteristics of its treatment in COVID-19 patients (Q20-21)
Posted at 00:09h
in
Natural coagulopathy and characteristics of its treatment in COVID-19 patients (Q20-21)
Q20-21_CDM
Overview
What is the issue?
- Cohort studies have suggested that SARS-CoV-2 infection promotes abnormalities in blood coagulation that could lead to arterial thromboembolism (ATE) or venous thromboembolism (VTE).
- Few studies have examined how COVID-19-related thromboembolism risk evolved over time across different countries.
What was the aim of the study?
- Regulatory agencies from Canada, Europe, and the US established a collaboration to evaluate the risk of ATE and VTE in the 90 days after diagnosis of COVID-19 in ambulatory and hospital settings in the periods before and during vaccine availability.
How was the study conducted?
- A retrospective cohort study was conducted using routinely collected healthcare data from 7 countries: Canada, England, Germany, Italy, Netherlands, Spain, and the US.
- The study cohorts comprised patients aged 18 years or older initially diagnosed with COVID-19 in the ambulatory setting between April 2020 and December 2021. A secondary analysis was undertaken in patients diagnosed in a hospital setting in Canada, Spain, and the US.
- Patients were followed for 90 days after COVID-19 diagnosis to evaluate the risk of ATE (myocardial infarction or ischemic stroke) or VTE (acute deep venous thrombosis or pulmonary embolism).
- Country-level estimates of absolute risk of ATE and VTE were measured before (through November 2020) and during COVID-19 vaccine availability (after December 2020).
What did the study find?
- In the period before COVID-19 vaccine availability, about 1 million patients were diagnosed with COVID-19 in the ambulatory setting. The risk of ATE in the 90 days post-infection ranged from 0.11% (Canada) to 1.01% (US), and risk of VTE from 0.23% (Canada) to 0.84% (England).
- About 3.5 million patients were diagnosed with COVID-19 during the period of vaccine availability. The risk of ATE in the 90 days post-infection ranged from 0.06% (England) to 1.04% (US), and the risk of VTE ranged from 0.25% (England) to 1.02% (US).
- Variation in the risk of ATE and VTE across countries also was observed among patients diagnosed with COVID-19 in the hospital setting.
- Differences in healthcare systems, data sources, prevalence of underlying comorbid conditions in the study cohorts, and approaches to COVID-19 and ATE and VTE case definition may have contributed to the variation in thromboembolism risk estimates observed between countries.
Implications
- Differences in healthcare systems, data sources, prevalence of underlying comorbid conditions, and approaches to COVID-19 and thromboembolism case definition may have contributed to the variation in thromboembolism risk estimates observed between countries.
Key messages
- The risk of ATE and VTE among patients diagnosed with COVID-19 varied by country.
- This variation was observed among patients initially diagnosed in the ambulatory setting and the hospital setting, and before and during COVID-19 vaccine availability.
Manuscripts
Lo Re Iii V, Cocoros NM, Hubbard RA, Dutcher SK, Newcomb CW, Connolly JG, Perez-Vilar S, Carbonari DM, Kempner ME, Hernández-Muñoz JJ, Petrone AB, Pishko AM, Rogers Driscoll ME, Brash JT, Burnett S, Cohet C, Dahl M, DeFor TA, Delmestri A, Djibo DA, Duarte-Salles T, Harrington LB, Kampman M, Kuntz JL, Kurz X, Mercadé-Besora N, Pawloski PA, Rijnbeek PR, Seager S, Steiner CA, Verhamme K, Wu F, Zhou Y, Burn E, Paterson JM, Prieto-Alhambra D. Risk of Arterial and Venous Thrombotic Events Among Patients with COVID-19: A Multi-National Collaboration of Regulatory Agencies from Canada, Europe, and United States. Clin Epidemiol. 2024 Feb 10;16:71-89.