{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:58:10Z","timestamp":1785437890744,"version":"3.56.0"},"reference-count":44,"publisher":"North Carolina Institute of Medicine","issue":"2","license":[{"start":{"date-parts":[[2023,3,6]],"date-time":"2023-03-06T00:00:00Z","timestamp":1678060800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"\n Background<\/jats:title>\n Some patients with COVID-19 develop life-threatening thrombotic complications including myocardial infarction, deep vein thrombosis, pulmonary embolism, disseminated intravascular coagulation, and ischemic stroke. These inflammatory and hypercoagulable states have been well documented in patient cohorts from metropolitan areas, but not in more rural populations, nor has a data-driven treatment plan been developed for thrombotic COVID-19 patients.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We undertook a retrospective case-control study of COVID-19-positive patients to analyze the impact of thrombosis on various clinical endpoints including terminal diagnosis and disease severity. Prevalence and impact of thrombosis were determined using medical records from 2237 COVID-19-positive patients hospitalized in Cumberland County, North Carolina. Odds ratios for terminal diagnosis, death, ICU admission, and ventilation were calculated based on thrombosis status, D-dimer level, or type of antithrombotic treatment.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Terminal diagnosis [OR 1.81; 95% CI (1.10, 2.98)], ICU admission [2.25; (1.33, 3.81)], and ventilation [2.46; (1.45, 4.18)] were all more likely in thrombotic patients (N = 97) compared to nonthrombotic patients (N = 2140) after adjusting for age. D-dimer levels were associated with death overall, but not among thrombotic patients. Treatments that combined antiplatelet and anticoagulant drugs appeared to be more efficacious than anticoagulants alone in preventing death and severe disease.<\/jats:p>\n <\/jats:sec>\n \n Limitations<\/jats:title>\n Patient medical history prior to hospitalization was not evaluated.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n In this cohort, those with thrombosis are at increased risk for adverse outcomes including death and severe disease. Antithrombotic therapy that includes antiplatelet drugs provides improved outcomes. Higher-powered prospective trials will be necessary to confirm any potential merits of antiplatelet therapy.<\/jats:p>\n <\/jats:sec>","DOI":"10.18043\/001c.73024","type":"journal-article","created":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T09:15:59Z","timestamp":1678785359000},"source":"Crossref","is-referenced-by-count":0,"title":["Retrospective Study of Thrombosis in Hospitalized Patients with COVID-19 in Rural North Carolina"],"prefix":"10.18043","volume":"84","author":[{"given":"Amanda","family":"Brechko","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00dv9q566","id-type":"ROR","asserted-by":"publisher"}],"name":"Campbell University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Jiroutek","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00dv9q566","id-type":"ROR","asserted-by":"publisher"}],"name":"Campbell University","department":["College of Pharmacy & Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyla","family":"Jones","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00dv9q566","id-type":"ROR","asserted-by":"publisher"}],"name":"Campbell University","department":["Jerry M. Wallace School of Osteopathic Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonnie","family":"Brenseke","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00dv9q566","id-type":"ROR","asserted-by":"publisher"}],"name":"Campbell University","department":["Jerry M. Wallace School of Osteopathic Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald C.","family":"Maharty","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00dv9q566","id-type":"ROR","asserted-by":"publisher"}],"name":"Campbell University","department":["Jerry M. Wallace School of Osteopathic Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Cappola","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00dv9q566","id-type":"ROR","asserted-by":"publisher"}],"name":"Campbell University","department":["Jerry M. Wallace School of Osteopathic Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen P.","family":"Holly","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00dv9q566","id-type":"ROR","asserted-by":"publisher"}],"name":"Campbell University","department":["College of Pharmacy & Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"7507","published-online":{"date-parts":[[2023,3,6]]},"reference":[{"issue":"3","key":"ref1","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1182\/bloodadvances.2020003763","article-title":"American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19","volume":"5","author":"Adam Cuker","year":"2021","journal-title":"Blood Adv","ISSN":"https:\/\/id.crossref.org\/issn\/2473-9529","issn-type":"print"},{"issue":"9","key":"ref2","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1056\/nejmoa2105911","article-title":"Therapeutic anticoagulation with heparin in noncritically ill patients with Covid-19","volume":"385","author":"The ATTACC, ACTIV-4a, and REMAP-CAP Investigators","year":"2021","journal-title":"New England Journal of Medicine","ISSN":"https:\/\/id.crossref.org\/issn\/0028-4793","issn-type":"print"},{"issue":"9","key":"ref3","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1056\/nejmoa2103417","article-title":"Therapeutic anticoagulation with heparin in critically ill patients with Covid-19","volume":"385","author":"The REMAP-CAP, ACTIV-4a, and ATTACC Investigators","year":"2021","journal-title":"New England Journal of Medicine","ISSN":"https:\/\/id.crossref.org\/issn\/0028-4793","issn-type":"print"},{"issue":"4","key":"ref4","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1182\/blood.2020006520","article-title":"COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection","volume":"136","author":"Hanny Al-Samkari","year":"2020","journal-title":"Blood","ISSN":"https:\/\/id.crossref.org\/issn\/0006-4971","issn-type":"print"},{"issue":"1","key":"ref5","doi-asserted-by":"publisher","first-page":"e001628","DOI":"10.1136\/openhrt-2021-001628","article-title":"Role of combining anticoagulant and antiplatelet agents in COVID-19 treatment: a rapid review","volume":"8","author":"Kamal Matli","year":"2021","journal-title":"Open Heart","ISSN":"https:\/\/id.crossref.org\/issn\/2053-3624","issn-type":"print"},{"issue":"4","key":"ref6","doi-asserted-by":"publisher","first-page":"602","DOI":"10.1111\/jrh.12511","article-title":"COVID-19 death rates are higher in rural counties with larger shares of Blacks and Hispanics","volume":"36","author":"Kent Jason G. 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