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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Autores principales:	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, Hiroaki Takeuchi, Shuji Tohda, Akihiro Hirakawa, Tetsuo Sasano, Hirokuni Arai, Yasuhiro Otomo, Yasunari Miyazaki, Shinsuke Yasuda
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	thrombosis COVID-19 coagulopathy D-dimer variant of concern Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/ba016bd5bb554ddf8922b6a10c25e452
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spelling	oai:doaj.org-article:ba016bd5bb554ddf8922b6a10c25e4522021-11-19T05:23:11ZArterial and Venous Thrombosis Complicated in COVID-19: A Retrospective Single Center Analysis in Japan2297-055X10.3389/fcvm.2021.767074https://doaj.org/article/ba016bd5bb554ddf8922b6a10c25e4522021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.767074/fullhttps://doaj.org/toc/2297-055XBackground: 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.Seiya ObaTadashi HosoyaMiki AmamiyaTakahiro MitsumuraDaisuke KawataHirokazu SasakiMari KamiyaAkio YamamotoTakahiro AndoSho ShimadaTsuyoshi ShiraiTsukasa OkamotoTomoya TateishiAkira EndoJunichi AiboshiNobuyuki NosakaHideo YamanouchiToyomu UgawaEiki NagaokaKeiji OiSusumu TaoYasuhiro MaejimaYukie TanakaKousuke TanimotoKousuke TanimotoHiroaki TakeuchiShuji TohdaAkihiro HirakawaTetsuo SasanoHirokuni AraiYasuhiro OtomoYasunari MiyazakiShinsuke YasudaFrontiers Media S.A.articlethrombosisCOVID-19coagulopathyD-dimervariant of concernDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	thrombosis COVID-19 coagulopathy D-dimer variant of concern Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	thrombosis COVID-19 coagulopathy D-dimer variant of concern Diseases of the circulatory (Cardiovascular) system RC666-701 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
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.
format	article
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
title	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_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_sort	arterial and venous thrombosis complicated in covid-19: a retrospective single center analysis in japan
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/ba016bd5bb554ddf8922b6a10c25e452
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Arterial and Venous Thrombosis Complicated in COVID-19: A Retrospective Single Center Analysis in Japan

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