Arterial and Venous Thrombotic Events in Patients with COVID-19 Compared to Influenza

Saturday, August 27, 2022

1:15 PM – 1:30 PM CEST

Location: Congress Hall D2

Publication Number: 158

Background: There are important knowledge gaps on the incidence of arterial thromboembolism (ATE) and venous thromboembolism (VTE) with COVID-19. It is unclear if these complications are more frequent for COVID-19 compared to other respiratory viral infections.

Objectives: To estimate the risk of ATE and VTE in patients with COVID-19 and compare those risks to patients with influenza.

Methods: We conducted a retrospective cohort study using claims data from 6 Data Partners in the US FDA Sentinel System: 2 national health insurers and 4 regional integrated delivery systems. Patients were ≥ 18 years of age with COVID-19 (Apr - Nov 2020) or influenza (Oct 2018 - Apr 2019) identified via ICD-10-CM diagnosis or positive PCR test in any care setting. We estimated the 90-day absolute risk of ATE (acute myocardial infarction, stroke) and VTE (pulmonary embolism, deep vein thrombosis), separately, during or resulting in hospitalization, via diagnosis codes. We assessed all-cause mortality within 30 days of ATE or VTE. To control for differences in baseline characteristics between cohorts, we calculated propensity scores (PS) and applied PS fine stratification. We calculated stratum-specific weights and used weighted Cox regression accounting for PS and adjusted for Data Partner to estimate hazard ratios (HR) and robust 95% confidence intervals for outcomes comparing COVID-19 to influenza.

Results: We identified 352,432 patients with COVID-19 and 127,183 patients with influenza. The 90-day risk of ATE was 2.7% (95% CI, 2.6-2.7%) among COVID-19 patients and 1.4% (95% CI, 1.3-1.4%) among influenza patients. The risk of ATE was higher for patients with COVID-19 than influenza, overall (HR=1.10 [1.04-1.17]) and when the index diagnosis was in ambulatory settings (HR=1.53 [1.38-1.69]), with no association when the index diagnosis was in the hospital (HR=1.04 [0.97-1.11]). After an ATE event, the risk of death within 30 days was higher with COVID-19 than influenza (HR=3.11 [2.56-3.78]). The 90-day risk of VTE was 1.7% (1.7-1.8%) for COVID-19 and 0.5% (0.5-0.6%) for influenza. The risk of VTE was higher for patients with COVID-19 than influenza (HR=1.95 [1.79-2.13]); the association was larger when the index COVID-19 diagnosis was in ambulatory settings (HR=2.86 [2.46-3.32]) than in the hospital (HR=1.60 [1.43-1.79]). After a VTE event, the risk of death within 30 days was higher for COVID-19 patients (HR=3.06 [2.12-4.40]).

Conclusions: Patients with COVID-19 in April-November 2020 had a higher risk of VTE than patients with 2018-19 influenza, and there was some evidence of increased risk of ATE. After an inpatient ATE or VTE event, the risk of death was more than 3 times higher for patients with COVID-19 versus influenza.

Presenting Author(s)

Noelle M. Cocoros, DSc

Epidemiologist
Harvard Pilgrim Health Care Institute
Boston, Massachusetts, United States

Slides

Co-Author(s)

SD

Sarah Dutcher, PhD, MS

Epidemiologist
U.S. Food and Drug Administration
Silver Spring, MD, United States
JC

John Connolly

Harvard Pilgrim Health Care Institute
Boston, MA, United States
Silvia Perez-Vilar, PhD

Senior Epidemiologist
US Food and Drug Administration
Silver Spring, Maryland, United States
DC

Dena Carbonari

University of Pennsylvania, Pennsylvania, United States
TD

Terese Defor

HealthPartners Institute, United States
Djeneba Audrey Djibo

CVS Health Clinical Trials Services
Jenkintown, Pennsylvania, United States
LH

Laura Harrington, PhD, MPH

Assistant Investigator
Kaiser Permanente Washington Health Research Institute
Seattle, WA, United States
LH

Laura Hou

Research Analyst II
Harvard Pilgrim Health Care Institute, United States
Sean Hennessy, Pharm. D., Ph.D.

Professor
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, The University of Pennsylvania
Philadelphia, PA, United States
RH

Rebecca Hubbard, Ph.D.

Professor
1Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, The University of Pennsylvania
Philadelphia, Pennsylvania, United States
MK

Maria Kempner, BA

Senior Research Analyst
Harvard Pilgrim Health Care Institute, United States
JK

Jennifer Kuntz, PhD

Kaiser Permanente Center for Health Research
Portland, Oregon, United States
CM

Cheryl N McMahill-Walraven, PhD

Director, Safety & Surveillance
CVS Health Clinical Trial Services
Blue Bell, PA, United States
JM

Jolene Mosley

Harvard Pilgrim Health Care Institute, United States
PP

Pamala Pawloski, Pharm.D.

Sr Research Investigator
HealthPartners Institute
St Paul, Minnesota, United States
AP

Andrew Petrone

Lead SAS Programmer/Analyst
Harvard Pilgrim Health Care Institute, United States
AP

Allyson Pishko

University of Pennsylvania, United States
MR

Meighan Rogers Driscoll

Harvard Pilgrim Health Care Institute, United States
CS

Claudia Steiner

Kaiser Permanente Colorado Institute for Health Research, United States
YZ

Yunping Zhou

Humana Healthcare Research, Inc., United States
Vincent Lo Re, III, MD, MSCE, FISPE

Associate Professor of Medicine and Epidemiology, University of Pennsylvania
UPenn Center for Pharmacoepidemiology Research & Training
Philadelphia, Pennsylvania, United States