COVID-19–Related Thrombotic and Bleeding Events in Adults With Congenital Heart Disease
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Author
Fusco, F.Krasuski, R.A.
Sadeghi, S.
Rosenbaum, M.S.
Lewis, M.J.
Carazo, M.R.
Rodriguez, F.H., 3rd
Halpern, D.G.
Feinberg, J.L.
Galilea, F.A.
Baraona, F.
Cedars, A.M.
Ko, J.M.
Porayette, P.
Maldonado, J.R.
Frogoudaki, A.A.
Nir, A.
Chaudhry, A.
John, A.S.
Karbassi, A.
Ganame, J.
Hoskoppal, A.
Frischhertz, B.P.
Hendrickson, B.
Rodriguez-Monserrate, C.P.
Broda, C.R.
Tobler, D.
Gregg, D.
Martinez-Quintana, E.
Yeung, E.
Krieger, E.V.
Ruperti-Repilado, F.J.
Giannakoulas, G.
Lui, G.K.
Ephrem, G.
Singh, H.S.
Hasan, A.
Bartlett, H.L.
Lindsay, I.
Grewal, J.
Nicolarsen, J.
Araujo, J.J.
Cramer, J.W.
Bouchardy, J.
Al, Najashi, K.
Ryan, K.
Alshawabkeh, L.
Andrade, L.
Ladouceur, M.
Schwerzmann, M.
Greutmann, M.
Merás, P.
Ferrero, P.
Dehghani, P.
Tung, P.P.
Garcia-Orta, R.
Tompkins, R.
Gendi, S.M.
Cohen, S.
Klewer, S.E.
Hascoet, S.
Upadhyay, S.
Fisher, S.D.
Cook, S.
Cotts, T.B.
Kovacs, A.H.
Aboulhosn, J.A.
Scognamiglio, G.
Broberg, C.S.
Sarubbi, B.
Affiliation
University of ArizonaIssue Date
2023-12-02
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Elsevier B.V.Citation
Fusco, F, Krasuski, R, Sadeghi, S. et al. COVID-19–Related Thrombotic and Bleeding Events in Adults With Congenital Heart Disease. JACC Adv. 2023 Dec, 2 (10). https://doi.org/10.1016/j.jacadv.2023.100701Journal
JACC: AdvancesRights
© 2023, The Authors. Published by Elsevier on Behalf of The American College of Cardiology Foundation. This is an Open Access Article under the CC BY-NC-ND License (http://creativecommons.org/licenses/by-nc-nd/4.0/).Collection Information
This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.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. © 2023 The AuthorsNote
Open access journalISSN
2772-963XVersion
Final Published Versionae974a485f413a2113503eed53cd6c53
10.1016/j.jacadv.2023.100701
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Except where otherwise noted, this item's license is described as © 2023, The Authors. Published by Elsevier on Behalf of The American College of Cardiology Foundation. This is an Open Access Article under the CC BY-NC-ND License (http://creativecommons.org/licenses/by-nc-nd/4.0/).