Thromboembolic risk in hospitalised and non-hospitalised Covid-19 patients: a self-controlled case series analysis of a nation-wide cohort

Ho, F. K., Man, K. K.S., Toshner, M., Church, C., Celis-Morales, C. , Wong, I. C.K., Berry, C. , Sattar, N. and Pell, J. P. (2021) Thromboembolic risk in hospitalised and non-hospitalised Covid-19 patients: a self-controlled case series analysis of a nation-wide cohort. Mayo Clinic Proceedings, (doi: 10.1016/j.mayocp.2021.07.002) (PMCID:PMC8282478) (In Press)

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Abstract

Objective: An unexpectedly large number of people infected with Covid-19 had experienced a thrombotic event. This study aims to assess the associations between Covid-19 infection and thromboembolism including myocardial infarction (MI), ischaemic stroke, deep-vein thrombosis (DVT), and pulmonary embolism (PE). Patients and Methods: A self-controlled case-series study was conducted covering the whole of Scotland’s general population. The study population comprised individuals with confirmed (positive test) Covid-19 and at least one thromboembolic event between March 2018 and October 2020. Their incidence rates during the risk interval (5 days before to 56 days after the positive test) and the control interval (the remaining periods) were compared intra-personally. Results: Across Scotland, 1,449 individuals tested positive for Covid-19 and experienced a thromboembolic event. The risk of thromboembolism was significantly elevated over the whole risk period but highest in the 7 days following the positive test (IRR 12.01, 95% CI 9.91-14.56) in all included individuals. The association was also present in individuals not originally hospitalised for Covid-19 (IRR 4.07, 95% CI 2.83-5.85). Risk of MI, stroke, PE and DVT were all significantly higher in the week following a positive test. The risk of PE and DVT was particularly high and remained significantly elevated even 56 days following the test. Conclusion: Confirmed Covid-19 infection was associated with early elevations in risk with MI, ischaemic stroke, and substantially stronger and prolonged elevations with DVT and PE both in hospital and community settings. Clinicians should consider thromboembolism, especially PE, among people with Covid-19 in the community.

Item Type:Articles
Keywords:Covid-19, thromboembolism, stroke.
Status:In Press
Refereed:Yes
Glasgow Author(s) Enlighten ID:Berry, Professor Colin and Pell, Professor Jill and Celis, Dr Carlos and Ho, Dr Frederick and Sattar, Professor Naveed and Church, Dr Colin
Authors: Ho, F. K., Man, K. K.S., Toshner, M., Church, C., Celis-Morales, C., Wong, I. C.K., Berry, C., Sattar, N., and Pell, J. P.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
Journal Name:Mayo Clinic Proceedings
Publisher:Elsevier
ISSN:0025-6196
ISSN (Online):1942-5546
Published Online:16 July 2021
Copyright Holders:Copyright © 2021 Mayo Foundation for Medical Education and Research
First Published:First published in Mayo Clinic Proceedings 2021
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
312033COVID-19 infection and subsequent thromboembolic eventsKa-Wing HoWellcome Trust (WELLCOTR)N/AHW - Public Health
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science