Association of COVID-19 With Major Arterial and Venous Thrombotic Diseases: A Population-Wide Cohort Study of 48 Million Adults in England and Wales
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- Rochelle Knight
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.).
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- Venexia Walker
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.).
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- Samantha Ip
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK.
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- Jennifer A. Cooper
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.).
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- Thomas Bolton
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK.
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- Spencer Keene
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK.
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- Rachel Denholm
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.).
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- Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea University, Wales, UK (A.A., H.A., F.T.).
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- Hoda Abbasizanjani
- Population Data Science, Swansea University Medical School, Swansea University, Wales, UK (A.A., H.A., F.T.).
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- Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea University, Wales, UK (A.A., H.A., F.T.).
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- Efosa Omigie
- National Health Service Digital, Leeds, UK (E.O., S.H.).
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- Sam Hollings
- National Health Service Digital, Leeds, UK (E.O., S.H.).
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- Teri-Louise North
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.).
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- Renin Toms
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.).
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- Xiyun Jiang
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK.
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- Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK.
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- Spiros Denaxas
- Health Data Research UK (S.D.), London.
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- Johan H. Thygesen
- Institute of Health Informatics (S.D., J.H.T., C.T.), University College London, UK.
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- Christopher Tomlinson
- Institute of Health Informatics (S.D., J.H.T., C.T.), University College London, UK.
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- Ben Bray
- School of Population Health and Environmental Sciences, King’s College London, UK (B.B.).
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- Craig J. Smith
- Geoffrey Jefferson Brain Research Centre, Manchester Centre for Clinical Neurosciences, Northern Care Alliance National Health Service Foundation Trust, Salford Royal Hospital, UK (C.J.S.).
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- Mark Barber
- Glasgow Caledonian University, UK (M.B.).
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- Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, UK (K.K.).
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- George Davey Smith
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.).
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- Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCL, Institute of Cardiovascular Science (N.C.), University College London, UK.
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- Cathie Sudlow
- British Heart Foundation Data Science Centre (T.B., C.S.), London.
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- William N. Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, UK (W.N.W.).
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- Angela M. Wood
- British Heart Foundation Cardiovascular Epidemiology Unit (S.I., T.B., S.K., X.J., E.D.A., A.M.W.), University of Cambridge, UK.
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- Jonathan A.C. Sterne
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, UK (R.K., V.W., J.A.C., R.D., T.-L.N., R.T., G.D.S., J.A.C.S.).
抄録
<jats:sec> <jats:title>Background:</jats:title> <jats:p>Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces a prothrombotic state, but long-term effects of COVID-19 on incidence of vascular diseases are unclear.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>We studied vascular diseases after COVID-19 diagnosis in population-wide anonymized linked English and Welsh electronic health records from January 1 to December 7, 2020. We estimated adjusted hazard ratios comparing the incidence of arterial thromboses and venous thromboembolic events (VTEs) after diagnosis of COVID-19 with the incidence in people without a COVID-19 diagnosis. We conducted subgroup analyses by COVID-19 severity, demographic characteristics, and previous history.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Among 48 million adults, 125 985 were hospitalized and 1 319 789 were not hospitalized within 28 days of COVID-19 diagnosis. In England, there were 260 279 first arterial thromboses and 59 421 first VTEs during 41.6 million person-years of follow-up. Adjusted hazard ratios for first arterial thrombosis after COVID-19 diagnosis compared with no COVID-19 diagnosis declined from 21.7 (95% CI, 21.0–22.4) in week 1 after COVID-19 diagnosis to 1.34 (95% CI, 1.21–1.48) during weeks 27 to 49. Adjusted hazard ratios for first VTE after COVID-19 diagnosis declined from 33.2 (95% CI, 31.3–35.2) in week 1 to 1.80 (95% CI, 1.50–2.17) during weeks 27 to 49. Adjusted hazard ratios were higher, for longer after diagnosis, after hospitalized versus nonhospitalized COVID-19, among Black or Asian versus White people, and among people without versus with a previous event. The estimated whole-population increases in risk of arterial thromboses and VTEs 49 weeks after COVID-19 diagnosis were 0.5% and 0.25%, respectively, corresponding to 7200 and 3500 additional events, respectively, after 1.4 million COVID-19 diagnoses.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>High relative incidence of vascular events soon after COVID-19 diagnosis declines more rapidly for arterial thromboses than VTEs. However, incidence remains elevated up to 49 weeks after COVID-19 diagnosis. These results support policies to prevent severe COVID-19 by means of COVID-19 vaccines, early review after discharge, risk factor control, and use of secondary preventive agents in high-risk patients.</jats:p> </jats:sec>
収録刊行物
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- Circulation
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Circulation 146 (12), 892-906, 2022-09-20
Ovid Technologies (Wolters Kluwer Health)