Arterial and Venous Thrombosis Complicated in COVID-19: A Retrospective Single Center Analysis in Japan
Background: Thrombosis is a characteristic complication in coronavirus disease 2019 (COVID-19). Since coagulopathy has been observed over the entire clinical course, thrombosis might be a clue to understanding the specific pathology in COVID-19. Currently, there is limited epidemiological data of CO...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-11-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2021.767074/full |
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| author | Seiya Oba Tadashi Hosoya Miki Amamiya Takahiro Mitsumura Daisuke Kawata Hirokazu Sasaki Mari Kamiya Akio Yamamoto Takahiro Ando Sho Shimada Tsuyoshi Shirai Tsukasa Okamoto Tomoya Tateishi Akira Endo Junichi Aiboshi Nobuyuki Nosaka Hideo Yamanouchi Toyomu Ugawa Eiki Nagaoka Keiji Oi Susumu Tao Yasuhiro Maejima Yukie Tanaka Kousuke Tanimoto Kousuke Tanimoto Hiroaki Takeuchi Shuji Tohda Akihiro Hirakawa Tetsuo Sasano Hirokuni Arai Yasuhiro Otomo Yasunari Miyazaki Shinsuke Yasuda |
| author_facet | Seiya Oba Tadashi Hosoya Miki Amamiya Takahiro Mitsumura Daisuke Kawata Hirokazu Sasaki Mari Kamiya Akio Yamamoto Takahiro Ando Sho Shimada Tsuyoshi Shirai Tsukasa Okamoto Tomoya Tateishi Akira Endo Junichi Aiboshi Nobuyuki Nosaka Hideo Yamanouchi Toyomu Ugawa Eiki Nagaoka Keiji Oi Susumu Tao Yasuhiro Maejima Yukie Tanaka Kousuke Tanimoto Kousuke Tanimoto Hiroaki Takeuchi Shuji Tohda Akihiro Hirakawa Tetsuo Sasano Hirokuni Arai Yasuhiro Otomo Yasunari Miyazaki Shinsuke Yasuda |
| author_sort | Seiya Oba |
| collection | DOAJ |
| description | Background: Thrombosis is a characteristic complication in coronavirus disease 2019 (COVID-19). Since coagulopathy has been observed over the entire clinical course, thrombosis might be a clue to understanding the specific pathology in COVID-19. Currently, there is limited epidemiological data of COVID-19-associated thrombosis in the Japanese population and none regarding variant strains of SARS-CoV-2. Here, we elucidate the risk factors and the pattern of thrombosis in COVID-19 patients.Methods: The patients consecutively admitted to Tokyo Medical and Dental University Hospital with COVID-19 were retrospectively analyzed. SARS-CoV-2 variants of concern/interest (VOC/VOI) carrying the spike protein mutants E484K, N501Y, or L452R were identified by PCR-based analysis. All thrombotic events were diagnosed by clinical symptoms, ultrasonography, and/or radiological tests.Results: Among the 516 patients, 32 patients experienced 42 thromboembolic events. Advanced age, severe respiratory conditions, and several abnormal laboratory markers were associated with the development of thrombosis. While thrombotic events occurred in 13% of the patients with a severe respiratory condition, those events still occurred in 2.5% of the patients who did not require oxygen therapy. Elevated D-dimer and ferritin levels on admission were independent risk factors of thrombosis (adjusted odds ratio 9.39 and 3.11, 95% confidence interval 2.08–42.3, and 1.06–9.17, respectively). Of the thrombotic events, 22 were venous, whereas 20 were arterial. While patients with thrombosis received anticoagulation and antiinflammatory therapies with a higher proportion, the mortality rate, organ dysfunctions, and bleeding complications in these patients were higher than those without thrombosis. The incidence of thrombosis in COVID-19 became less frequent over time, such as during the replacement of the earlier strains of SARS-CoV-2 by VOC/VOI and during increased use of anticoagulatory therapeutics.Conclusion: This study elucidated that elevated D-dimer and ferritin levels are useful biomarkers of thrombosis in COVID-19 patients. The comparable incidence of arterial thrombosis with venous thrombosis and the development of thrombosis in less severe patients required further considerations for the management of Japanese patients with COVID-19. Further studies would be required to identify high-risk populations and establish appropriate interventions for thrombotic complications in COVID-19. |
| first_indexed | 2024-12-19T02:55:47Z |
| format | Article |
| id | doaj.art-ba016bd5bb554ddf8922b6a10c25e452 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-19T02:55:47Z |
| publishDate | 2021-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-ba016bd5bb554ddf8922b6a10c25e4522022-12-21T20:38:20ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2021-11-01810.3389/fcvm.2021.767074767074Arterial and Venous Thrombosis Complicated in COVID-19: A Retrospective Single Center Analysis in JapanSeiya Oba0Tadashi Hosoya1Miki Amamiya2Takahiro Mitsumura3Daisuke Kawata4Hirokazu Sasaki5Mari Kamiya6Akio Yamamoto7Takahiro Ando8Sho Shimada9Tsuyoshi Shirai10Tsukasa Okamoto11Tomoya Tateishi12Akira Endo13Junichi Aiboshi14Nobuyuki Nosaka15Hideo Yamanouchi16Toyomu Ugawa17Eiki Nagaoka18Keiji Oi19Susumu Tao20Yasuhiro Maejima21Yukie Tanaka22Kousuke Tanimoto23Kousuke Tanimoto24Hiroaki Takeuchi25Shuji Tohda26Akihiro Hirakawa27Tetsuo Sasano28Hirokuni Arai29Yasuhiro Otomo30Yasunari Miyazaki31Shinsuke Yasuda32Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanTrauma and Acute Critical Care Medical Center, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanTrauma and Acute Critical Care Medical Center, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Intensive Care Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Intensive Care Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Intensive Care Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanResearch Core, Institute of Research, Tokyo Medical and Dental University (TMDU), Tokyo, JapanResearch Core, Institute of Research, Tokyo Medical and Dental University (TMDU), Tokyo, JapanGenome Laboratory, Medical Research Institute, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Molecular Virology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan0Clinical Laboratory, Tokyo Medical and Dental University (TMDU) Hospital, Tokyo, Japan1Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanTrauma and Acute Critical Care Medical Center, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanDepartment of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, JapanBackground: Thrombosis is a characteristic complication in coronavirus disease 2019 (COVID-19). Since coagulopathy has been observed over the entire clinical course, thrombosis might be a clue to understanding the specific pathology in COVID-19. Currently, there is limited epidemiological data of COVID-19-associated thrombosis in the Japanese population and none regarding variant strains of SARS-CoV-2. Here, we elucidate the risk factors and the pattern of thrombosis in COVID-19 patients.Methods: The patients consecutively admitted to Tokyo Medical and Dental University Hospital with COVID-19 were retrospectively analyzed. SARS-CoV-2 variants of concern/interest (VOC/VOI) carrying the spike protein mutants E484K, N501Y, or L452R were identified by PCR-based analysis. All thrombotic events were diagnosed by clinical symptoms, ultrasonography, and/or radiological tests.Results: Among the 516 patients, 32 patients experienced 42 thromboembolic events. Advanced age, severe respiratory conditions, and several abnormal laboratory markers were associated with the development of thrombosis. While thrombotic events occurred in 13% of the patients with a severe respiratory condition, those events still occurred in 2.5% of the patients who did not require oxygen therapy. Elevated D-dimer and ferritin levels on admission were independent risk factors of thrombosis (adjusted odds ratio 9.39 and 3.11, 95% confidence interval 2.08–42.3, and 1.06–9.17, respectively). Of the thrombotic events, 22 were venous, whereas 20 were arterial. While patients with thrombosis received anticoagulation and antiinflammatory therapies with a higher proportion, the mortality rate, organ dysfunctions, and bleeding complications in these patients were higher than those without thrombosis. The incidence of thrombosis in COVID-19 became less frequent over time, such as during the replacement of the earlier strains of SARS-CoV-2 by VOC/VOI and during increased use of anticoagulatory therapeutics.Conclusion: This study elucidated that elevated D-dimer and ferritin levels are useful biomarkers of thrombosis in COVID-19 patients. The comparable incidence of arterial thrombosis with venous thrombosis and the development of thrombosis in less severe patients required further considerations for the management of Japanese patients with COVID-19. Further studies would be required to identify high-risk populations and establish appropriate interventions for thrombotic complications in COVID-19.https://www.frontiersin.org/articles/10.3389/fcvm.2021.767074/fullthrombosisCOVID-19coagulopathyD-dimervariant of concern |
| spellingShingle | Seiya Oba Tadashi Hosoya Miki Amamiya Takahiro Mitsumura Daisuke Kawata Hirokazu Sasaki Mari Kamiya Akio Yamamoto Takahiro Ando Sho Shimada Tsuyoshi Shirai Tsukasa Okamoto Tomoya Tateishi Akira Endo Junichi Aiboshi Nobuyuki Nosaka Hideo Yamanouchi Toyomu Ugawa Eiki Nagaoka Keiji Oi Susumu Tao Yasuhiro Maejima Yukie Tanaka Kousuke Tanimoto Kousuke Tanimoto Hiroaki Takeuchi Shuji Tohda Akihiro Hirakawa Tetsuo Sasano Hirokuni Arai Yasuhiro Otomo Yasunari Miyazaki Shinsuke Yasuda Arterial and Venous Thrombosis Complicated in COVID-19: A Retrospective Single Center Analysis in Japan Frontiers in Cardiovascular Medicine thrombosis COVID-19 coagulopathy D-dimer variant of concern |
| title | Arterial and Venous Thrombosis Complicated in COVID-19: A Retrospective Single Center Analysis in Japan |
| title_full | Arterial and Venous Thrombosis Complicated in COVID-19: A Retrospective Single Center Analysis in Japan |
| title_fullStr | Arterial and Venous Thrombosis Complicated in COVID-19: A Retrospective Single Center Analysis in Japan |
| title_full_unstemmed | Arterial and Venous Thrombosis Complicated in COVID-19: A Retrospective Single Center Analysis in Japan |
| title_short | Arterial and Venous Thrombosis Complicated in COVID-19: A Retrospective Single Center Analysis in Japan |
| title_sort | arterial and venous thrombosis complicated in covid 19 a retrospective single center analysis in japan |
| topic | thrombosis COVID-19 coagulopathy D-dimer variant of concern |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2021.767074/full |
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