Incidence and risk of post-COVID-19 thromboembolic disease and the impact of aspirin prescription; nationwide observational cohort at the US Department of Veteran Affairs

COVID-19 triggers prothrombotic and proinflammatory changes, with thrombotic disease prevalent in up to 30% SARS-CoV-2 infected patients. Early work suggests that aspirin could prevent COVID-19 related thromboembolic disorders in some studies but not others. This study leverages data from the larges...

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Published in:	PloS one Vol. 19; no. 9; p. e0302612
Main Authors:	Ware, Anna D, Veigulis, Zachary P, Hoover, Peter J, Blumke, Terri L, Ioannou, George N, Boyko, Edward J, Osborne, Thomas F
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 17-09-2024
Subjects:	Aged Aged, 80 and over Aspirin Aspirin - therapeutic use Biology and Life Sciences Body mass index Cardiovascular disease Cardiovascular diseases Care and treatment Clinical trials Comorbidity Complications and side effects Contingency tables COVID-19 COVID-19 - complications COVID-19 - epidemiology COVID-19 - prevention & control COVID-19 vaccines Diagnosis Disorders Dosage and administration Electronic health records Electronic medical records Electronic records Embolism Embolisms Ethnicity Female Health aspects Heart Heart diseases Humans Immunization Incidence Infections Ischemia Lung diseases Male Medical records Medical research Medicine and Health Sciences Medicine, Experimental Middle Aged Mortality Observational studies Patients Pulmonary embolism Retrospective Studies Risk Factors SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Stroke Stroke (Disease) Thromboembolism Thromboembolism - drug therapy Thromboembolism - epidemiology Thromboembolism - etiology Thromboembolism - prevention & control Thrombosis United States - epidemiology United States Department of Veterans Affairs Veterans United States United States > US
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Summary:	COVID-19 triggers prothrombotic and proinflammatory changes, with thrombotic disease prevalent in up to 30% SARS-CoV-2 infected patients. Early work suggests that aspirin could prevent COVID-19 related thromboembolic disorders in some studies but not others. This study leverages data from the largest integrated healthcare system in the United States to better understand this association. Our objective was to evaluate the incidence and risk of COVID-19 associated acute thromboembolic disorders and the potential impact of aspirin. This retrospective, observational study utilized national electronic health record data from the Veterans Health Administration. 334,374 Veterans who tested positive for COVID-19 from March 2, 2020, to June 13, 2022, were included, 81,830 of whom had preexisting aspirin prescription prior to their COVID-19 diagnosis. Patients with and without aspirin prescriptions were matched and the odds of post-COVID acute thromboembolic disorders were assessed. 10.1% of Veterans had a documented thromboembolic disorder within 12 months following their COVID-19 diagnosis. Those with specific comorbidities were at greatest risk. Preexisting aspirin prescription was associated with a significant decrease risk of post-COVID-19 thromboembolic disorders, including pulmonary embolism (OR [95% CI]: 0.69 [0.65, 0.74]) and deep vein thrombosis (OR [95% CI]: 0.76 [0.69, 0.83], but an increased risk of acute arterial diseases, including ischemic stroke (OR [95% CI]: 1.54 [1.46, 1.60]) and acute ischemic heart disease (1.33 [1.26, 1.39]). Findings demonstrated that preexisting aspirin prescription prior to COVID-19 diagnosis was associated with significantly decreased risk of venous thromboembolism and pulmonary embolism but increased risk of acute arterial disease. The risk of arterial disease may be associated with increased COVID-19 prothrombotic effects superimposed on preexisting chronic cardiovascular disease for which aspirin was already prescribed. Prospective clinical trials may help to further assess the efficacy of aspirin use prior to COVID-19 diagnosis for the prevention of post-COVID-19 thromboembolic disorders.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0302612