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Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales
Circulation, Volume: 146, Issue: 12, Pages: 892 - 906
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Background:Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces a prothrombotic state, but long-term effects of COVID-19 on incidence of vascular diseases are unclear.Methods:We studied vascular diseases after COVID-19 diagnosis in population-wide anonymized linked Eng...
Ovid Technologies (Wolters Kluwer Health)
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Background:Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces a prothrombotic state, but long-term effects of COVID-19 on incidence of vascular diseases are unclear.Methods:We studied vascular diseases after COVID-19 diagnosis in population-wide anonymized linked English and Welsh electronic health records from January 1 to December 7, 2020. We estimated adjusted hazard ratios comparing the incidence of arterial thromboses and venous thromboembolic events (VTEs) after diagnosis of COVID-19 with the incidence in people without a COVID-19 diagnosis. We conducted subgroup analyses by COVID-19 severity, demographic characteristics, and previous history.Results:Among 48 million adults, 125 985 were hospitalized and 1 319 789 were not hospitalized within 28 days of COVID-19 diagnosis. In England, there were 260 279 first arterial thromboses and 59 421 first VTEs during 41.6 million person-years of follow-up. Adjusted hazard ratios for first arterial thrombosis after COVID-19 diagnosis compared with no COVID-19 diagnosis declined from 21.7 (95% CI, 21.0–22.4) in week 1 after COVID-19 diagnosis to 1.34 (95% CI, 1.21–1.48) during weeks 27 to 49. Adjusted hazard ratios for first VTE after COVID-19 diagnosis declined from 33.2 (95% CI, 31.3–35.2) in week 1 to 1.80 (95% CI, 1.50–2.17) during weeks 27 to 49. Adjusted hazard ratios were higher, for longer after diagnosis, after hospitalized versus nonhospitalized COVID-19, among Black or Asian versus White people, and among people without versus with a previous event. The estimated whole-population increases in risk of arterial thromboses and VTEs 49 weeks after COVID-19 diagnosis were 0.5% and 0.25%, respectively, corresponding to 7200 and 3500 additional events, respectively, after 1.4 million COVID-19 diagnoses.Conclusions:High relative incidence of vascular events soon after COVID-19 diagnosis declines more rapidly for arterial thromboses than VTEs. However, incidence remains elevated up to 49 weeks after COVID-19 diagnosis. These results support policies to prevent severe COVID-19 by means of COVID-19 vaccines, early review after discharge, risk factor control, and use of secondary preventive agents in high-risk patients.
Faculty of Medicine, Health and Life Sciences
This work was funded by the Longitudinal Health and Wellbeing COVID-19 National Core Study, which was established by the UK Chief Scientific Officer in October 2020 and funded by UK Research and Innovation (grant references MC_PC_20030 and MC_PC_20059); by the British Heart Foundation as part of the British Heart Foundation Data Science Center led by Health Data Research UK (British Heart Foundation grant number SP/19/3/34678); by the Data and Connectivity National Core Study led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (grant reference MC_PC_20058); by the CONVALESCENCE study of long COVID-19 funded by National Institute for Health and Care Research (NIHR)/UK Research and Innovation; by the Con-COV team funded by the Medical Research Council (grant number MR/V028367/1); by Health Data Research UK, which receives its funding from Health Data Research UK Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation, and the Wellcome Trust; by core funding from the British Heart Foundation (RG/13/13/30194; RG/18/13/33946), British Heart Foundation Cambridge CRE (RE/13/6/30180), and NIHR Cambridge Biomedical Research Center (BRC-1215-20014); by the ADR Wales program of work, which is aligned to the priority themes as identified in the Welsh Government’s national strategy: Prosperity for All (ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods at Cardiff University, and specialist teams within the Welsh Government to develop new evidence that supports Prosperity for All by using the SAIL Databank at Swansea University to link and analyze anonymized data; ADR Wales is part of the Economic and Social Research Council [part of UK Research and Innovation] funded ADR UK [grant ES/S007393/1]); by the Wales COVID-19 Evidence Center, funded by Health and Care Research Wales; and by the BigData@Heart Consortium, funded by the Innovative Medicines Initiative-2 Joint Undertaking under grant agreement 116074. Dr Ip was funded by a British Heart Foundation–Turing Cardiovascular Data Science 419 Award (BCDSA/100005) and is funded by the International Alliance for Cancer Early Detection, a partnership among Cancer Research UK C18081/A31373, Canary Center at Stanford University, the University of Cambridge, OHSU Knight Cancer Institute, University College London, and the University of Manchester. R. Knight and Drs Cooper and Sterne were supported by the NIHR Bristol Biomedical Research Center. R. Knight and Drs Walker and Davey Smith were supported by the Medical Research Council Integrative Epidemiology Unit at the University of Bristol (MC_UU_00011/1). R. Knight was supported by NIHR ARC West. Drs Denholm and Sterne were supported by Health Data Research UK. S. Keene is funded by the NIHR Blood and Transplant Research Unit in Donor Health and Genomics (NIHR BTRU-2014-10024). X. Jiang was funded by the Health Data Research UK–Turing Wellcome PhD Programme in Health Data Science. Dr Wood was supported by the British Heart Foundation–Turing Cardiovascular Data Science Award (BCDSA/100005). Dr Whiteley is supported by the Chief Scientist’s Office (CAF/01/17). Drs Sudlow, Smith, Barber, Wood, and Whiteley are supported by the Stroke Association (SA CV 20/100018). C. Tomlinson is supported by a University College London UK Research and Innovation Center for Doctoral Training in AI-Enabled Healthcare studentship (EP/S021612/1), Medical Research Council Clinical Top-Up, and a studentship from the NIHR Biomedical Research Center at University College London Hospital National Health Service Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.