Scimeca Giovanni, Krishnathasan Darsiya, Rashedi Sina, Lan Zhou, Sato Alyssa, Hamade Nada, Bejjani Antoine, Khairani Candrika D, Davies Julia, Porio Nicole, Assi Ali A, Armero Andre, Tristani Anthony, Ortiz-Rios Marcos D, Nauffal Victor, Almarzooq Zaid, Wei Eric, Zuluaga-Sánchez Valeria, Zarghami Mehrdad, Achanta Aditya, Jesudasen Sirus J, Tiu Bruce, Merli Geno J, Leiva Orly, Fanikos John, Sharma Aditya, Rizzo Samantha, Pfeferman Mariana B, Morrison Ruth B, Vishnevsky Alec, Hsia Judith, Nehler Mark R, Welker James, Bonaca Marc P, Carroll Brett, Goldhaber Samuel Z, Campia Umberto, Bikdeli Behnood, Piazza Gregory
Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Mount Auburn Hospital, Harvard Medical School, Boston, MA, USA.
J Thromb Thrombolysis. 2025 Apr;58(4):485-496. doi: 10.1007/s11239-025-03078-2. Epub 2025 Mar 10.
COVID-19 is associated with an increased risk of venous thromboembolism (VTE) in hospitalized patients. Although prior studies have attempted to identify predictors of VTE, restricted sample size and use of administrative claims data have limited such analyses. We utilized data from hospitalized patients in the CORONA-VTE Network, a United States multicenter registry of adult patients with PCR-confirmed COVID-19 (N = 3,844). The primary outcome was time-to-first event for a composite of adjudicated pulmonary embolism or deep vein thrombosis during 90-day follow-up. The candidate variables were selected by a priori clinical consensus. We conducted cause-specific Cox regression analysis adjusted for the selected variables for each imputed dataset and pooled the estimated HRs for reporting (p < 0.05 for significance). VTE occurred in 206 patients, with a cumulative incidence of 5.3% at 90 days. The covariates associated with increased risk of VTE were history of VTE (HR: 1.71; 95% CI: 1.11-2.63), corticosteroid therapy (HR: 1.76; 95% CI: 1.32-2.33) and known thrombophilia (HR: 3.56; 95% CI: 1.54-8.21) while therapeutic anticoagulation at baseline (HR: 0.42; 95% CI: 0.26-0.69), antecedent use of statins (HR: 0.67; 95% CI: 0.50-0.90), and prophylactic anticoagulation during hospitalization (HR: 0.52; 95% CI: 0.38-0.71) were associated with reduced risk of VTE. While prior VTE, corticosteroid therapy, and known thrombophilia were associated with an increased risk of VTE, prescriptions of prophylactic and therapeutic anticoagulation, and statins were associated with a decreased risk. Once externally validated, these findings may inform risk assessment in hospitalized patients with COVID-19.
新冠病毒病（COVID-19）与住院患者静脉血栓栓塞症（VTE）风险增加相关。尽管既往研究试图确定VTE的预测因素，但样本量有限以及使用行政索赔数据限制了此类分析。我们利用了CORONA-VTE网络中住院患者的数据，这是一个美国成人患者PCR确诊COVID-19的多中心注册研究（N = 3844）。主要结局是在90天随访期间判定的肺栓塞或深静脉血栓形成复合事件的首次发生时间。候选变量通过先验临床共识选择。我们对每个插补数据集针对选定变量进行了特定病因的Cox回归分析，并汇总估计的HR用于报告（显著性p < 0.05）。206例患者发生VTE，90天时累积发病率为5.3%。与VTE风险增加相关的协变量包括VTE病史（HR：1.71；95% CI：1.11 - 2.63）、皮质类固醇治疗（HR：1.76；95% CI：1.32 - 2.33）和已知的血栓形成倾向（HR：3.56；95% CI：1.54 - 8.21），而基线时的治疗性抗凝（HR：0.42；95% CI：0.26 - 0.69）、先前使用他汀类药物（HR：0.67；95% CI：0.50 - 0.90）以及住院期间的预防性抗凝（HR：0.52；95% CI：0.38 - 0.71）与VTE风险降低相关。虽然既往VTE、皮质类固醇治疗和已知的血栓形成倾向与VTE风险增加相关，但预防性和治疗性抗凝以及他汀类药物的处方与风险降低相关。一旦经过外部验证，这些发现可能为COVID-19住院患者的风险评估提供参考。
