Clinical Features Comparing Arterial Thrombosis and Venous Thromboembolism in Hospitalized Patients with COVID-19: Result from the CLOT-COVID Study

Michihisa Umetsu; Hajime Kanamori; Koji Murakami; Takuya Shiga; Sen Yachi; Makoto Takeyama; Yuji Nishimoto; Ichizo Tsujino; Junichi Nakamura; Naoto Yamamoto; Hiroko Nakata; Satoshi Ikeda; Shizu Aikawa; Hiroya Hayashi; Hirono Satokawa; Yoshinori Okuno; Eriko Iwata; Yoshito Ogihara; Nobutaka Ikeda; Akane Kondo; Takehisa Iwai; Norikazu Yamada; Tomohiro Ogawa; Takao Kobayashi; Makoto Mo; Yugo Yamashita

doi:10.3400/avd.oa.22-00112

Clinical Features Comparing Arterial Thrombosis and Venous Thromboembolism in Hospitalized Patients with COVID-19: Result from the CLOT-COVID Study

Ann Vasc Dis. 2023 Jun 25;16(2):115-123. doi: 10.3400/avd.oa.22-00112.

Authors

Michihisa Umetsu¹, Hajime Kanamori¹, Koji Murakami¹, Takuya Shiga¹, Sen Yachi², Makoto Takeyama², Yuji Nishimoto³, Ichizo Tsujino⁴, Junichi Nakamura⁴, Naoto Yamamoto⁵, Hiroko Nakata⁶, Satoshi Ikeda⁷, Shizu Aikawa⁸, Hiroya Hayashi⁹, Hirono Satokawa¹⁰, Yoshinori Okuno¹¹, Eriko Iwata¹², Yoshito Ogihara¹³, Nobutaka Ikeda¹⁴, Akane Kondo¹⁵, Takehisa Iwai¹⁶, Norikazu Yamada¹⁷, Tomohiro Ogawa¹⁸, Takao Kobayashi⁵, Makoto Mo¹⁹, Yugo Yamashita¹¹

Affiliations

¹ Tohoku University Hospital, Sendai, Miyagi, Japan.
² Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan.
³ Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan.
⁴ Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
⁵ Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan.
⁶ Yokosuka General Hospital Uwamachi, Yokosuka, Kanagawa, Japan.
⁷ Nagasaki University Hospital, Nagasaki, Nagasaki, Japan.
⁸ Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan.
⁹ Osaka Metropolitan University Graduate School of Medicine, Osaka, Osaka, Japan.
¹⁰ Fukushima Medical University, School of Medicine, Fukushima, Fukushima, Japan.
¹¹ Kyoto University Hospital, Kyoto, Kyoto, Japan.
¹² Nankai Medical Center Japan Community Health Care Organization, Saiki, Osaka, Japan.
¹³ Mie University Hospital, Tsu, Mie, Japan.
¹⁴ Toho University Ohashi Medical Center, Tokyo, Japan.
¹⁵ Shikoku Medical Center for Children and Adults, Zentsuji, Kagawa, Japan.
¹⁶ Tsukuba Vascular Center, Tsukuba, Ibaraki, Japan.
¹⁷ Kuwana City Medical Center, Kuwana, Mie, Japan.
¹⁸ Fukushima Daiichi Hospital, Fukushima, Fukushima, Japan.
¹⁹ Yokohama Minami Kyosai Hospital, Yokohama, Kanagawa, Japan.

Abstract

Objectives: This study aimed to investigate the clinical features of arterial thrombosis and venous thromboembolism (VTE) in coronavirus disease 2019 (COVID-19). Methods: The CLOT-COVID Study was a retrospective, multicenter cohort study that enrolled 2,894 consecutively hospitalized patients with COVID-19 among 16 centers in Japan from April 2021 to September 2021. We compared the clinical features of arterial thrombosis and VTE. Results: Thrombosis was observed in 55 patients (1.9%) during hospitalization. Arterial thrombosis and VTE occurred in 12 (0.4%) and 36 (1.2%) patients, respectively. Among the 12 patients with arterial thrombosis, 9 (75%), 2 (17%), and 1 developed ischemic cerebral infarction, myocardial infarction, and acute limb ischemia, respectively, and there were five patients (42%) without comorbidities. Among 36 patients with VTE, 19 (53%) and 17 (47%) developed pulmonary embolism (PE) and deep vein thrombosis (DVT), respectively. PE was common in the early stages of hospitalization; whereas, DVT was common beyond the early stages of hospitalization. Conclusion: Among patients with COVID-19, arterial thrombosis was less common than VTE, although ischemic cerebral infarction seemed to be relatively common, and a certain number of patients developed arterial thrombosis even in the absence of known atherosclerosis risk factors.

Keywords: COVID-19; Japan; VTE; arterial thrombosis; venous thrombosis.