Bristol, UK—Recovered COVID-19 patients should be screened for risk of vascular events and prescribed preventive therapies if found to be needed, according to a large new study.

"Strategies to prevent vascular events after COVID-19 are particularly important after severe COVID-19 leading to hospitalization and should include an early review in primary care and risk factor management," according to a UK study published recently in the journal Circulation.

University of Bristol–led researchers advised, "After severe COVID-19, individuals at high risk of vascular events should be prescribed preventive therapies and counseled about the importance of adherence to them."

They reached that conclusion after in a cohort study of 48 million adults in England and Wales. The authors report that COVID-19 was associated with a substantial excess incidence of both arterial thromboses and venous thromboembolism, although those declined with time from COVID-19 diagnosis.

That was especially the case for patients who had been hospitalized with COVID-19; their excess incidence was higher for a longer time. The study pointed out that an estimated 10,500 excess arterial thromboses and venous thromboembolic events (VTEs) after 1.4 million COVID-19 diagnoses.

Background information in the article notes that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes a prothrombotic state. It had been unclear, however, what the long-term effects of COVID-19 on the incidence of vascular diseases had been.

To remedy that, the study team looked at vascular disease incidence after COVID-19 diagnosis in population-wide anonymized linked English and Welsh electronic health records from January1, 2020, to December 7, 2020. The incidence of arterial thromboses and VTEs after diagnosis of COVID-19 was compared with the incidence in people without a COVID-19 diagnosis.

Among the 48 million adults in the cohort, 125,985 were hospitalized and 1.3 million were not hospitalized within 28 days of COVID-19 diagnosis. The researchers pointed out that in England, 260,279 first arterial thromboses and 59,421 first VTEs occurred during 41.6 million person-years of follow-up.

The results indicated that adjusted hazard ratios (aHRs) 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. The aHRs 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.

The authors advised that aHRs were higher for longer after diagnosis for:

• Hospitalized versus nonhospitalized COVID-19 patients
• Black or Asian versus white people
• People without versus a previous event.

"The estimated whole-population increases in the risk of arterial thromboses and VTEs 49 weeks after COVID-19 diagnosis were 0.5% and 0.25%, respectively, corresponding to 7,200 and 3,500 additional events, respectively, after 1.4 million COVID-19 diagnoses," the authors wrote.

The researchers added, "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."

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