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 H. Kovacs, Jamil A. Aboulhosn, Giancarlo Scognamiglio, Craig S. Broberg, Berardo Sarubbi

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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 languageEnglish (US)
Article number100701
JournalJACC: Advances
Issue number10
StatePublished - Dec 2023

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Dentistry (miscellaneous)

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