In the largest study of its kind, the Feinstein Institute for Medical Research and the Northwell COVID-19 research consortium reveal the risk of blood clots and the benefits of anticoagulation in hospitalized patients with 2019 coronavirus disease (COVID-19) who were recently discharged from the hospital. The report, recently published in a journal Blood, finds that prophylactic anticoagulants reduce the risk of major thromboembolic events and death by 46 percent.
Alex C. Spyropoulos, Ph.D. Med., A professor at the Feinstein institutes talks to a colleague. Credit for the painting: Feinstein Institutes
The future multicenter registry, called CORE-19, examined 4,906 adult patients with COVID-19 who were hospitalized at Northwell Health Hospital, New York City’s largest health care system, from March 1 to May 31, 2020, and was led by Alex C. Spyropoulos, Dr. Med., Professor at the Feinstein Institutes.
Although blood clots were observed in patients with COVID-19 during hospitalization, there was very little data to assess thrombotic risk and death, as well as predictors in the post-discharge period. The study attempted to identify venous thromboembolism (VTE), such as deep vein thrombosis (DVT) and pulmonary embolism (PE), and arterial thromboembolism (ATE), such as stroke and myocardial infarction (MI), in patients discharged from the hospital within 90 days.
There are three main outcomes from the CORE-19 study. First, the results showed that VTE, ATE, and all-cause mortality (ACM) occurred more than clinicians previously thought, in 7.13 percent (350/4906 patients) of cases. Second, key risk factors for major thromboembolic events and death include advanced age, cardiovascular risk factors (such as coronary artery disease, occlusive carotid disease, peripheral artery disease), personal history of VTE, chronic CKD kidney disease, intensive care, and increased risk score. for VTE (using the IMPROVE risk tool developed by Dr. Spyropoulos ’team and used nationally). Third, anticoagulants after release, mostly in prophylactic doses, reduce the risk of major thromboembolic events and death by 46 percent.
“Since the onset of the pandemic, we have seen blood clots pose a fatal risk to patients during hospitalization with COVID-19, but for those discharged, the prevalence and risk factors associated with thromboembolic events were not known,” said Dr. Spyropoulos, principal investigator of the study.
This large data set provides valuable insights and treatment options for patient recovery. “
Alex C. Spyropoulos, Ph.D. Med., Professor at the Feinstein Institutes
The study showed an overall rate of 7.13 percent of episodes after discharge, including:
- It will cause a mortality rate of almost 5 percent;
- ATE rate of 1.71 percent (i.e., stroke, embolism);
- VTE rate of 1.55 percent (i.e., mainly pulmonary embolism).
This study reveals that it is important to monitor COVID-19 survivors for dangerous blood clots even after they leave the hospital. Studying the vast population of patients treated at Northwell Health, Dr. Spyropoulos and his team have laid a solid foundation leading future clinical trials. “
Kevin J. Tracey, Ph.D. Med., President and CEO, Feinstein Institutes
Researchers dr. Spyropoulos and the Feinstein Institute were leaders during the COVID-19 pandemic in efforts to prevent blood clots from forming in patients. Since May 2020, the team has enrolled hospitalized patients in a randomized controlled clinical trial called HEP-COVID, which aims to study the safety and efficacy of low-dose heparin as a prophylactic blood clot. In addition, others. Spyropoulos is a member of the executive board of the national PREVENT-HD clinical trial that wants to evaluate the benefits of anticoagulation in high-risk outpatients with COVID-19.
The Northwell Health Research Consortium began in early 2020 and has organized more than 500 clinicians, statisticians and scientists across the Feinstein Institutes and Northwell Health to conduct state-of-the-art research on the COVID-19 pandemic. To date, more than 300 high-impact manuscripts have been written dealing with the most important issues surrounding the virus.
The CORE-19 registry was partially funded by the Broxmeyer Clinical Thrombosis Fellowship and Janssen Pharmaceuticals. Dimitri Giannis, Ph.D. Med., Who is an associate of dr. Spyropoulos from clinical thrombosis, developed a database and is the first author on Blood publishing.
Feinstein Institute for Medical Research at Northwell Health