Importance The incidence of arterial thromboembolism and venous thromboembolism in persons with COVID-19 remains unclear. Objective To measure the 90-day risk of arterial thromboembolism and venous thromboembolism in patients hospitalized with COVID-19 before or during COVID-19 vaccine availability vs patients hospitalized with influenza. Design, Setting, and Participants Retrospective cohort study of 41 443 patients hospitalized with COVID-19 before vaccine availability (April-November 2020), 44 194 patients hospitalized with COVID-19 during vaccine availability (December 2020-May 2021), and 8269 patients hospitalized with influenza (October 2018-April 2019) in the US Food and Drug Administration Sentinel System (data from 2 national health insurers and 4 regional integrated health systems). Exposures COVID-19 or influenza (identified by hospital diagnosis or nucleic acid test). Main Outcomes and Measures Hospital diagnosis of arterial thromboembolism (acute myocardial infarction or ischemic stroke) and venous thromboembolism (deep vein thrombosis or pulmonary embolism) within 90 days. Outcomes were ascertained through July 2019 for patients with influenza and through August 2021 for patients with COVID-19. Propensity scores with fine stratification were developed to account for differences between the influenza and COVID-19 cohorts. Weighted Cox regression was used to estimate the adjusted hazard ratios (HRs) for outcomes during each COVID-19 vaccine availability period vs the influenza period. Results A total of 85 637 patients with COVID-19 (mean age, 72 [SD, 13.0] years; 50.5% were male) and 8269 with influenza (mean age, 72 [SD, 13.3] years; 45.0% were male) were included. The 90-day absolute risk of arterial thromboembolism was 14.4% (95% CI, 13.6%-15.2%) in patients with influenza vs 15.8% (95% CI, 15.5%-16.2%) in patients with COVID-19 before vaccine availability (risk difference, 1.4% [95% CI, 1.0%-2.3%]) and 16.3% (95% CI, 16.0%-16.6%) in patients with COVID-19 during vaccine availability (risk difference, 1.9% [95% CI, 1.1%-2.7%]). Compared with patients with influenza, the risk of arterial thromboembolism was not significantly higher among patients with COVID-19 before vaccine availability (adjusted HR, 1.04 [95% CI, 0.97-1.11]) or during vaccine availability (adjusted HR, 1.07 [95% CI, 1.00-1.14]). The 90-day absolute risk of venous thromboembolism was 5.3% (95% CI, 4.9%-5.8%) in patients with influenza vs 9.5% (95% CI, 9.2%-9.7%) in patients with COVID-19 before vaccine availability (risk difference, 4.1% [95% CI, 3.6%-4.7%]) and 10.9% (95% CI, 10.6%-11.1%) in patients with COVID-19 during vaccine availability (risk difference, 5.5% [95% CI, 5.0%-6.1%]). Compared with patients with influenza, the risk of venous thromboembolism was significantly higher among patients with COVID-19 before vaccine availability (adjusted HR, 1.60 [95% CI, 1.43-1.79]) and during vaccine availability (adjusted HR, 1.89 [95% CI, 1.68-2.12]). Conclusions and Relevance Based on data from a US public health surveillance system, hospitalization with COVID-19 before and during vaccine availability, vs hospitalization with influenza in 2018-2019, was significantly associated with a higher risk of venous thromboembolism within 90 days, but there was no significant difference in the risk of arterial thromboembolism within 90 days.

中文翻译：

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COVID-19 与流感与住院患者动脉和静脉血栓事件风险的关联。

重要性 COVID-19 患者的动脉血栓栓塞和静脉血栓栓塞的发生率仍不清楚。目的 衡量在 COVID-19 疫苗可用之前或期间因 COVID-19 住院的患者与因流感住院的患者相比，90 天动脉血栓栓塞和静脉血栓栓塞风险。设计、设置和参与者 对 41443 名在疫苗可用前（2020 年 4 月至 11 月）因 COVID-19 住院的患者、44194 名在疫苗可用期间因 COVID-19 住院的患者（2020 年 12 月至 2021 年 5 月）和 8269 名患者的回顾性队列研究美国食品和药物管理局哨兵系统中因流感住院（2018 年 10 月至 2019 年 4 月）（数据来自 2 个国家健康保险公司和 4 个区域综合卫生系统）。暴露于 COVID-19 或流感（通过医院诊断或核酸检测确定）。主要观察指标 90 天内医院诊断为动脉血栓栓塞（急性心肌梗死或缺血性卒中）和静脉血栓栓塞（深静脉血栓或肺栓塞）。截至 2019 年 7 月，流感患者和 COVID-19 患者的结果已确定至 2021 年 8 月。开发了具有精细分层的倾向评分，以解释流感和 COVID-19 队列之间的差异。加权 Cox 回归用于估计每个 COVID-19 疫苗可用性期间与流感期间结果的调整后风险比 (HR)。结果 共有 85637 名 COVID-19 患者（平均年龄 72 [SD，13.0] 岁；50.5% 为男性）和 8269 名流感患者（平均年龄，72 [SD, 13.3] 岁；45.0% 为男性）。在疫苗可用之前，流感患者动脉血栓栓塞的 90 天绝对风险为 14.4%（95% CI，13.6%-15.2%），而 COVID-19 患者为 15.8%（95% CI，15.5%-16.2%） （风险差异，1.4% [95% CI，1.0%-2.3%]）和 16.3%（95% CI，16.0%-16.6%）在疫苗可用期间 COVID-19 患者（风险差异，1.9% [95%置信区间，1.1%-2.7%]）。与流感患者相比，COVID-19 患者在疫苗上市前（调整后的 HR，1.04 [95% CI，0.97-1.11]）或疫苗上市期间（调整后的 HR，1.07 [95]）的动脉血栓栓塞风险并未显着升高% 置信区间，1.00-1.14]）。流感患者的 90 天静脉血栓栓塞绝对风险为 5.3%（95% CI，4.9%-5.8%），而流感患者为 9.5%（95% CI，9.2%-9. 7%）在疫苗可用前的 COVID-19 患者中（风险差异，4.1% [95% CI，3.6%-4.7%]）和 10.9%（95% CI，10.6%-11.1%）在 COVID-19 患者中在疫苗供应期间（风险差异，5.5% [95% CI, 5.0%-6.1%]）。与流感患者相比，COVID-19 患者在疫苗可用前（调整后的 HR，1.60 [95% CI，1.43-1.79]）和疫苗可用期间（调整后的 HR，1.89 [95%] 发生静脉血栓栓塞的风险显着更高置信区间，1.68-2.12]）。结论和相关性根据美国公共卫生监测系统的数据，与 2018-2019 年因流感住院相比，在疫苗可用之前和期间因 COVID-19 住院与 90 天内静脉血栓栓塞风险较高显着相关，