COVID-19–Related Thrombotic and Bleeding Events in Adults With Congenital Heart Disease

Flavia Fusco; Richard A. Krasuski; Soraya Sadeghi; Marlon S. Rosenbaum; Matthew J. Lewis; Matthew R. Carazo; Fred H. Rodriguez; Dan G. Halpern; Jodi L. Feinberg; Francisca A. Galilea; Fernando Baraona; Ari M. Cedars; Jong M. Ko; Prashob Porayette; Jennifer R. Maldonado; Alexandra A. Frogoudaki; Amiram Nir; Anisa Chaudhry; Anitha S. John; Arsha Karbassi; Javier Ganame; Arvind Hoskoppal; Benjamin P. Frischhertz; Benjamin Hendrickson; Carla P. Rodriguez-Monserrate; Christopher R. Broda; Daniel Tobler; David Gregg; Efrén Martinez-Quintana; Elizabeth Yeung; Eric V. Krieger; Francisco J. Ruperti-Repilado; George Giannakoulas; George K. Lui; Georges Ephrem; Harsimran S. Singh; Almeneisi Hasan; Heather L. Bartlett; Ian Lindsay; Jasmine Grewal; Jeremy Nicolarsen; John J. Araujo; Jonathan W. Cramer; Judith Bouchardy; Khalid Al Najashi; Kristi Ryan; Laith Alshawabkeh; Lauren Andrade; Magalie Ladouceur; Markus Schwerzmann; Matthias Greutmann; Pablo Merás; Paolo Ferrero; Payam Dehghani; Poyee P. Tung; Rocio Garcia-Orta; Rose Tompkins; Salwa M. Gendi; Scott Cohen; Scott E. Klewer; Sebastien Hascoet; Shailendra Upadhyay; Stacy D. Fisher; Stephen Cook; Timothy B. Cotts; Adrienne Kovacs; Jamil A. Aboulhosn; Giancarlo Scognamiglio; Craig S. Broberg; Berardo Sarubbi

doi:10.1016/j.jacadv.2023.100701

COVID-19–Related Thrombotic and Bleeding Events in Adults With Congenital Heart Disease

Flavia Fusco, Richard A. Krasuski, Soraya Sadeghi, Marlon S. Rosenbaum, Matthew J. Lewis, Matthew R. Carazo, Fred H. Rodriguez, Dan G. Halpern, Jodi L. Feinberg, Francisca A. Galilea, Fernando Baraona, Ari M. Cedars, Jong M. Ko, Prashob Porayette, Jennifer R. Maldonado, Alexandra A. Frogoudaki, Amiram Nir, Anisa Chaudhry, Anitha S. John, Arsha KarbassiJavier Ganame, Arvind Hoskoppal, Benjamin P. Frischhertz, Benjamin Hendrickson, Carla P. Rodriguez-Monserrate, Christopher R. Broda, Daniel Tobler, David Gregg, Efrén Martinez-Quintana, Elizabeth Yeung, Eric V. Krieger, Francisco J. Ruperti-Repilado, George Giannakoulas, George K. Lui, Georges Ephrem, Harsimran S. Singh, Almeneisi Hasan, Heather L. Bartlett, Ian Lindsay, Jasmine Grewal, Jeremy Nicolarsen, John J. Araujo, Jonathan W. Cramer, Judith Bouchardy, Khalid Al Najashi, Kristi Ryan, Laith Alshawabkeh, Lauren Andrade, Magalie Ladouceur, Markus Schwerzmann, Matthias Greutmann, Pablo Merás, Paolo Ferrero, Payam Dehghani, Poyee P. Tung, Rocio Garcia-Orta, Rose Tompkins, Salwa M. Gendi, Scott Cohen, Scott E. Klewer, Sebastien Hascoet, Shailendra Upadhyay, Stacy D. Fisher, Stephen Cook, Timothy B. Cotts, Adrienne Kovacs, Jamil A. Aboulhosn, Giancarlo Scognamiglio, Craig S. Broberg, Berardo Sarubbi

Knight Cardiovascular Institute

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

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.

Original language	English (US)
Article number	100701
Journal	JACC: Advances
Volume	2
Issue number	10
DOIs	https://doi.org/10.1016/j.jacadv.2023.100701
State	Published - Dec 2023

Keywords

adult congenital heart disease
bleeding
COVID-19
thrombosis

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Dentistry (miscellaneous)

Access to Document

10.1016/j.jacadv.2023.100701

Cite this

Fusco, F., Krasuski, R. A., Sadeghi, S., Rosenbaum, M. S., Lewis, M. J., Carazo, M. R., Rodriguez, F. H., 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., ... Sarubbi, B. (2023). COVID-19–Related Thrombotic and Bleeding Events in Adults With Congenital Heart Disease. JACC: Advances, 2(10), Article 100701. https://doi.org/10.1016/j.jacadv.2023.100701

Fusco, F, Krasuski, RA, Sadeghi, S, Rosenbaum, MS, Lewis, MJ, Carazo, MR, Rodriguez, FH, Halpern, DG, Feinberg, JL, Galilea, FA, Baraona, F, Cedars, AM, Ko, JM, Porayette, P, Maldonado, JR, Frogoudaki, AA, Nir, A, Chaudhry, A, John, AS, Karbassi, A, Ganame, J, Hoskoppal, A, Frischhertz, BP, Hendrickson, B, Rodriguez-Monserrate, CP, Broda, CR, Tobler, D, Gregg, D, Martinez-Quintana, E, Yeung, E, Krieger, EV, Ruperti-Repilado, FJ, Giannakoulas, G, Lui, GK, Ephrem, G, Singh, HS, Hasan, A, Bartlett, HL, Lindsay, I, Grewal, J, Nicolarsen, J, Araujo, JJ, Cramer, JW, Bouchardy, J, Al Najashi, K, Ryan, K, Alshawabkeh, L, Andrade, L, Ladouceur, M, Schwerzmann, M, Greutmann, M, Merás, P, Ferrero, P, Dehghani, P, Tung, PP, Garcia-Orta, R, Tompkins, R, Gendi, SM, Cohen, S, Klewer, SE, Hascoet, S, Upadhyay, S, Fisher, SD, Cook, S, Cotts, TB, Kovacs, A, Aboulhosn, JA, Scognamiglio, G, Broberg, CS & Sarubbi, B 2023, 'COVID-19–Related Thrombotic and Bleeding Events in Adults With Congenital Heart Disease', JACC: Advances, vol. 2, no. 10, 100701. https://doi.org/10.1016/j.jacadv.2023.100701

@article{81fa2105fff0429cacc7c713f2cd092d,

title = "COVID-19–Related Thrombotic and Bleeding Events in Adults With Congenital Heart Disease",

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.",

keywords = "adult congenital heart disease, bleeding, COVID-19, thrombosis",

author = "Flavia Fusco and Krasuski, {Richard A.} and Soraya Sadeghi and Rosenbaum, {Marlon S.} and Lewis, {Matthew J.} and Carazo, {Matthew R.} and Rodriguez, {Fred H.} and Halpern, {Dan G.} and Feinberg, {Jodi L.} and Galilea, {Francisca A.} and Fernando Baraona and Cedars, {Ari M.} and Ko, {Jong M.} and Prashob Porayette and Maldonado, {Jennifer R.} and Frogoudaki, {Alexandra A.} and Amiram Nir and Anisa Chaudhry and John, {Anitha S.} and Arsha Karbassi and Javier Ganame and Arvind Hoskoppal and Frischhertz, {Benjamin P.} and Benjamin Hendrickson and Rodriguez-Monserrate, {Carla P.} and Broda, {Christopher R.} and Daniel Tobler and David Gregg and Efr{\'e}n Martinez-Quintana and Elizabeth Yeung and Krieger, {Eric V.} and Ruperti-Repilado, {Francisco J.} and George Giannakoulas and Lui, {George K.} and Georges Ephrem and Singh, {Harsimran S.} and Almeneisi Hasan and Bartlett, {Heather L.} and Ian Lindsay and Jasmine Grewal and Jeremy Nicolarsen and Araujo, {John J.} and Cramer, {Jonathan W.} and Judith Bouchardy and {Al Najashi}, Khalid and Kristi Ryan and Laith Alshawabkeh and Lauren Andrade and Magalie Ladouceur and Markus Schwerzmann and Matthias Greutmann and Pablo Mer{\'a}s and Paolo Ferrero and Payam Dehghani and Tung, {Poyee P.} and Rocio Garcia-Orta and Rose Tompkins and Gendi, {Salwa M.} and Scott Cohen and Klewer, {Scott E.} and Sebastien Hascoet and Shailendra Upadhyay and Fisher, {Stacy D.} and Stephen Cook and Cotts, {Timothy B.} and Adrienne Kovacs and Aboulhosn, {Jamil A.} and Giancarlo Scognamiglio and Broberg, {Craig S.} and Berardo Sarubbi",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2023",

month = dec,

doi = "10.1016/j.jacadv.2023.100701",

language = "English (US)",

volume = "2",

journal = "JACC: Advances",

issn = "2772-963X",

number = "10",

}

TY - JOUR

T1 - COVID-19–Related Thrombotic and Bleeding Events in Adults With Congenital Heart Disease

AU - Fusco, Flavia

AU - Krasuski, Richard A.

AU - Sadeghi, Soraya

AU - Rosenbaum, Marlon S.

AU - Lewis, Matthew J.

AU - Carazo, Matthew R.

AU - Rodriguez, Fred H.

AU - Halpern, Dan G.

AU - Feinberg, Jodi L.

AU - Galilea, Francisca A.

AU - Baraona, Fernando

AU - Cedars, Ari M.

AU - Ko, Jong M.

AU - Porayette, Prashob

AU - Maldonado, Jennifer R.

AU - Frogoudaki, Alexandra A.

AU - Nir, Amiram

AU - Chaudhry, Anisa

AU - John, Anitha S.

AU - Karbassi, Arsha

AU - Ganame, Javier

AU - Hoskoppal, Arvind

AU - Frischhertz, Benjamin P.

AU - Hendrickson, Benjamin

AU - Rodriguez-Monserrate, Carla P.

AU - Broda, Christopher R.

AU - Tobler, Daniel

AU - Gregg, David

AU - Martinez-Quintana, Efrén

AU - Yeung, Elizabeth

AU - Krieger, Eric V.

AU - Ruperti-Repilado, Francisco J.

AU - Giannakoulas, George

AU - Lui, George K.

AU - Ephrem, Georges

AU - Singh, Harsimran S.

AU - Hasan, Almeneisi

AU - Bartlett, Heather L.

AU - Lindsay, Ian

AU - Grewal, Jasmine

AU - Nicolarsen, Jeremy

AU - Araujo, John J.

AU - Cramer, Jonathan W.

AU - Bouchardy, Judith

AU - Al Najashi, Khalid

AU - Ryan, Kristi

AU - Alshawabkeh, Laith

AU - Andrade, Lauren

AU - Ladouceur, Magalie

AU - Schwerzmann, Markus

AU - Greutmann, Matthias

AU - Merás, Pablo

AU - Ferrero, Paolo

AU - Dehghani, Payam

AU - Tung, Poyee P.

AU - Garcia-Orta, Rocio

AU - Tompkins, Rose

AU - Gendi, Salwa M.

AU - Cohen, Scott

AU - Klewer, Scott E.

AU - Hascoet, Sebastien

AU - Upadhyay, Shailendra

AU - Fisher, Stacy D.

AU - Cook, Stephen

AU - Cotts, Timothy B.

AU - Kovacs, Adrienne

AU - Aboulhosn, Jamil A.

AU - Scognamiglio, Giancarlo

AU - Broberg, Craig S.

AU - Sarubbi, Berardo

PY - 2023/12

Y1 - 2023/12

N2 - 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.

AB - 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.

KW - adult congenital heart disease

KW - bleeding

KW - COVID-19

KW - thrombosis

UR - http://www.scopus.com/inward/record.url?scp=85180249648&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85180249648&partnerID=8YFLogxK

U2 - 10.1016/j.jacadv.2023.100701

DO - 10.1016/j.jacadv.2023.100701

M3 - Article

AN - SCOPUS:85180249648

SN - 2772-963X

VL - 2

JO - JACC: Advances

JF - JACC: Advances

IS - 10

M1 - 100701

ER -

COVID-19–Related Thrombotic and Bleeding Events in Adults With Congenital Heart Disease

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Cite this