Медицинская библиотека · JACC. Advances · 2023

COVID-19-Related Thrombotic and Bleeding Events in Adults With Congenital Heart Disease.

Fusco Flavia, Krasuski Richard A, Sadeghi Soraya, Rosenbaum Marlon S, Lewis Matthew J, Carazo Matthew R, Rodriguez Fred H, Halpern Dan G, Feinberg Jodi L, Galilea Francisca A, Baraona Fernando, Cedars Ari M, Ko Jong M, Porayette Prashob, Maldonado Jennifer R, Frogoudaki Alexandra A, Nir Amiram, Chaudhry Anisa, John Anitha S, Karbassi Arsha, Ganame Javier, Hoskoppal Arvind, Frischhertz Benjamin P, Hendrickson Benjamin, Rodriguez-Monserrate Carla P, Broda Christopher R, Tobler Daniel, Gregg David, Martinez-Quintana Efrén, Yeung Elizabeth, Krieger Eric V, Ruperti-Repilado Francisco J, Giannakoulas George, Lui George K, Ephrem Georges, Singh Harsimran S, Hasan Almeneisi, Bartlett Heather L, Lindsay Ian, Grewal Jasmine, Nicolarsen Jeremy, Araujo John J, Cramer Jonathan W, Bouchardy Judith, Al Najashi Khalid, Ryan Kristi, Alshawabkeh Laith, Andrade Lauren, Ladouceur Magalie, Schwerzmann Markus, Greutmann Matthias, Merás Pablo, Ferrero Paolo, Dehghani Payam, Tung Poyee P, Garcia-Orta Rocio, Tompkins Rose, Gendi Salwa M, Cohen Scott, Klewer Scott E, Hascoet Sebastien, Upadhyay Shailendra, Fisher Stacy D, Cook Stephen, Cotts Timothy B, Kovacs Adrienne H, Aboulhosn Jamil A, Scognamiglio Giancarlo, Broberg Craig S, Sarubbi Berardo

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Аннотация

BACKGROUND

Altered coagulation is a striking feature of COVID-19. Adult patients with congenital heart disease (ACHD) are prone to thromboembolic (TE) and bleeding complications.

OBJECTIVES

The purpose of this study was to investigate the prevalence and risk factors for COVID-19 TE/bleeding complications in ACHD patients.

METHODS

COVID-19-positive ACHD patients were included between May 2020 and November 2021. TE events included ischemic cerebrovascular accident, systemic and pulmonary embolism, deep venous thrombosis, myocardial infarction, and intracardiac thrombosis. Major bleeding included cases with hemoglobin drop >2 g/dl, involvement of critical sites, or fatal bleeding. Severe infection was defined as need for intensive care unit, endotracheal intubation, renal replacement therapy, extracorporeal membrane oxygenation, or death. Patients with TE/bleeding were compared to those without events. Factors associated with TE/bleeding were determined using logistic regression.

RESULTS

Of 1,988 patients (age 32 [IQR: 25-42] years, 47% male, 59 ACHD centers), 30 (1.5%) had significant TE/bleeding: 12 TE events, 12 major bleeds, and 6 with both TE and bleeding. Patients with TE/bleeding had higher in-hospital mortality compared to the remainder cohort (33% vs 1.7%; P < 0.0001) and were in more advanced physiological stage (P = 0.032) and NYHA functional class (P = 0.01), had lower baseline oxygen saturation (P = 0.0001), and more frequently had a history of atrial arrhythmia (P < 0.0001), previous hospitalization for heart failure (P < 0.0007), and were more likely hospitalized for COVID-19 (P < 0.0001). By multivariable logistic regression, prior anticoagulation (OR: 4.92; 95% CI: 2-11.76; P = 0.0003), cardiac injury (OR: 5.34; 95% CI: 1.98-14.76; P = 0.0009), and severe COVID-19 (OR: 17.39; 95% CI: 6.67-45.32; P < 0.0001) were independently associated with increased risk of TE/bleeding complications.

CONCLUSIONS

ACHD patients with TE/bleeding during COVID-19 infection have a higher in-hospital mortality from the illness. Risk of coagulation disorders is related to severe COVID-19, cardiac injury during infection, and use of anticoagulants.

Для цитирования: Fusco Flavia, Krasuski Richard A, Sadeghi Soraya, Rosenbaum Marlon S, Lewis Matthew J, Carazo Matthew R, Rodriguez Fred H, Halpern Dan G, Feinberg Jodi L, Galilea Francisca A, Baraona Fernando, Cedars Ari M, Ko Jong M, Porayette Prashob, Maldonado Jennifer R, Frogoudaki Alexandra A, Nir Amiram, Chaudhry Anisa, John Anitha S, Karbassi Arsha, Ganame Javier, Hoskoppal Arvind, Frischhertz Benjamin P, Hendrickson Benjamin, Rodriguez-Monserrate Carla P, Broda Christopher R, Tobler Daniel, Gregg David, Martinez-Quintana Efrén, Yeung Elizabeth, Krieger Eric V, Ruperti-Repilado Francisco J, Giannakoulas George, Lui George K, Ephrem Georges, Singh Harsimran S, Hasan Almeneisi, Bartlett Heather L, Lindsay Ian, Grewal Jasmine, Nicolarsen Jeremy, Araujo John J, Cramer Jonathan W, Bouchardy Judith, Al Najashi Khalid, Ryan Kristi, Alshawabkeh Laith, Andrade Lauren, Ladouceur Magalie, Schwerzmann Markus, Greutmann Matthias, Merás Pablo, Ferrero Paolo, Dehghani Payam, Tung Poyee P, Garcia-Orta Rocio, Tompkins Rose, Gendi Salwa M, Cohen Scott, Klewer Scott E, Hascoet Sebastien, Upadhyay Shailendra, Fisher Stacy D, Cook Stephen, Cotts Timothy B, Kovacs Adrienne H, Aboulhosn Jamil A, Scognamiglio Giancarlo, Broberg Craig S, Sarubbi Berardo. COVID-19-Related Thrombotic and Bleeding Events in Adults With Congenital Heart Disease.. JACC. Advances. 2023. DOI: 10.1016/j.jacadv.2023.100701.

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