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

DOI
Publisher DOI
PubMed ID
38938489
Abstract
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.
Date Issued
2023-12
Publication Type
Article
Subject(s)
Subjects
COVID-19 adult congenital heart disease bleeding thrombosis
Language(s)
en
Author(s)
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
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
Additional Credits
Journal
JACC. Advances.
Publisher
Elsevier
ISSN
2772-963X
Access(Rights)
open.access
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