Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

ISARIC Clinical Characterisation Group; Matthew J. Griffee; Patricia T. Bozza; Luis Felipe Reyes; Devin P. Eddington; Dorothea Rosenberger; Laura Merson; Barbara Wanjiru Citarella; Jonathon P. Fanning; Peta M.A. Alexander; John Fraser; Heidi Dalton; Sung-Min Cho

doi:10.1016/j.rpth.2023.102142

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

ISARIC Clinical Characterisation Group, Matthew J. Griffee, Patricia T. Bozza, Luis Felipe Reyes, Devin P. Eddington, Dorothea Rosenberger, Laura Merson, Barbara Wanjiru Citarella, Jonathon P. Fanning, Peta M.A. Alexander, John Fraser, Heidi Dalton, Sung-Min Cho

Research output: Contribution to journal › Article › peer-review

35 Downloads (Pure)

Abstract

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs).

Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality.

Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions.

Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51).

Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings.

Original language	English
Article number	102142
Number of pages	18
Journal	Research and Practice in Thrombosis and Haemostasis
Volume	7
Issue number	5
DOIs	https://doi.org/10.1016/j.rpth.2023.102142
Publication status	Published - 1 Jul 2023

Bibliographical note

Funding:
This work was made possible by the UK Foreign, Commonwealth and Development Office and Wellcome (215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z and 220757/Z/20/Z); the Bill & Melinda Gates Foundation (OPP1209135); philanthropic support of the donors to the University of Oxford’s COVID-19 Research Response Fund (0009109); CIHR Coronavirus Rapid Research Funding Opportunity OV2170359 and coordination in Canada by Sunnybrook Research Institute; funding by the Health Research Board of Ireland (CTN-2014-12); Rapid European COVID-19 Emergency Response research (H2020 project 101003589) and European Clinical Research Alliance on Infectious Diseases (965313); the Research Council of Norway grant no 312780, and a philanthropic donation from Vivaldi Invest A/S owned by Jon Stephenson von Tetzchner; the Comprehensive Local Research Networks, of which PJMO is an NIHR Senior Investigator (NIHR201385); Innovative Medicines Initiative Joint Undertaking under Grant Agreement No. 115523 Combating Bacterial Resistance in Europe, the resources of which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007- 2013) and European Federation of Pharmaceutical Industries and Associations companies, in-kind contribution; the French COVID cohort (NCT04262921) is sponsored by INSERM and is funded by the REACTing (REsearch & ACtion emergING infectious diseases) consortium and by a grant of the French Ministry of Health (PHRC n 20-0424); Stiftungsfonds zur Förderung der Bekämpfung der Tuberkulose und anderer Lungenkrankheiten of the City of Vienna, Project Number: APCOV22BGM; Italian Ministry of Health “Fondi Ricerca corrente–L1P6” to IRCCS Ospedale Sacro Cuore–Don Calabria; Australian Department of Health grant (3273191); Gender Equity Strategic Fund at University of Queensland, Artificial Intelligence for Pandemics (A14PAN) at University of Queensland, the Australian Research Council Centre of Excellence for Engineered Quantum Systems (CE170100009), the Prince Charles Hospital Foundation, Australia; Brazil, National Council for Scientific and Technological Development Scholarship number 303953/2018- 7; the Firland Foundation, Shoreline, Washington, USA; a grant from foundation Bevordering Onderzoek Franciscus; the South Eastern Norway Health Authority and the Research Council of Norway; Institute for Clinical Research, National Institutes of Health supported by the Ministry of Health Malaysia; grants from the National Institute for Health Research (NIHR; award CO-CIN-01), the Medical Research Council (grant MC_PC_19059), and by the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (award 200907), NIHR Health Protection Research Unit in Respiratory Infections at Imperial College London with Public Health England (award 200927), Liverpool Experimental Cancer Medicine Centre (grant C18616/A25153), NIHR Biomedical Research Centre at Imperial College London (award IS-BRC-1215-20013), and NIHR Clinical Research Network providing infrastructure support. M.J.G. received support through the Faculty Small Grant Program from the Vice President for Research of the University of Utah to fund statistical analysis. This project was supported by the University Research Committee and the Study Design and Biostatistics Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, Grant 8UL1TR000105 (formerly UL1RR025764)) at the University of Utah and by Universidad de La Sabana (MED-309-2021). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the University Research Committee, Vice President for Research Office, or University of Utah.

Keywords

COVID-19
developing countries
disseminated intravascular coagulation
hemorrhage
ischemic stroke
SARS-CoV-2
thromboembolism
thrombosis

Access to Document

10.1016/j.rpth.2023.102142Licence: Creative Commons: Attribution (CC BY)

GriffeeM2023ThromboticFinal published version, 3.23 MBLicence: Creative Commons: Attribution (CC BY)

Fingerprint

Dive into the research topics of 'Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry'. Together they form a unique fingerprint.

Cite this

ISARIC Clinical Characterisation Group, Griffee, M. J., Bozza, P. T., Reyes, L. F., Eddington, D. P., Rosenberger, D., Merson, L., Citarella, B. W., Fanning, J. P., Alexander, P. M. A., Fraser, J., Dalton, H., & Cho, S.-M. (2023). Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry. Research and Practice in Thrombosis and Haemostasis, 7(5), Article 102142. https://doi.org/10.1016/j.rpth.2023.102142

ISARIC Clinical Characterisation Group ; Griffee, Matthew J. ; Bozza, Patricia T. et al. / Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry. In: Research and Practice in Thrombosis and Haemostasis. 2023 ; Vol. 7, No. 5.

@article{8bf6a974a7db4ab4a6f63a95b90067d4,

title = "Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry",

abstract = "Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs).Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality.Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions.Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51).Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings.",

keywords = "COVID-19, developing countries, disseminated intravascular coagulation, hemorrhage, ischemic stroke, SARS-CoV-2, thromboembolism, thrombosis",

author = "{ISARIC Clinical Characterisation Group} and Griffee, {Matthew J.} and Bozza, {Patricia T.} and Reyes, {Luis Felipe} and Eddington, {Devin P.} and Dorothea Rosenberger and Laura Merson and Citarella, {Barbara Wanjiru} and Fanning, {Jonathon P.} and Alexander, {Peta M.A.} and John Fraser and Heidi Dalton and Sung-Min Cho and Christopher Green",

note = "Funding: This work was made possible by the UK Foreign, Commonwealth and Development Office and Wellcome (215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z and 220757/Z/20/Z); the Bill & Melinda Gates Foundation (OPP1209135); philanthropic support of the donors to the University of Oxford{\textquoteright}s COVID-19 Research Response Fund (0009109); CIHR Coronavirus Rapid Research Funding Opportunity OV2170359 and coordination in Canada by Sunnybrook Research Institute; funding by the Health Research Board of Ireland (CTN-2014-12); Rapid European COVID-19 Emergency Response research (H2020 project 101003589) and European Clinical Research Alliance on Infectious Diseases (965313); the Research Council of Norway grant no 312780, and a philanthropic donation from Vivaldi Invest A/S owned by Jon Stephenson von Tetzchner; the Comprehensive Local Research Networks, of which PJMO is an NIHR Senior Investigator (NIHR201385); Innovative Medicines Initiative Joint Undertaking under Grant Agreement No. 115523 Combating Bacterial Resistance in Europe, the resources of which are composed of financial contribution from the European Union{\textquoteright}s Seventh Framework Programme (FP7/2007- 2013) and European Federation of Pharmaceutical Industries and Associations companies, in-kind contribution; the French COVID cohort (NCT04262921) is sponsored by INSERM and is funded by the REACTing (REsearch & ACtion emergING infectious diseases) consortium and by a grant of the French Ministry of Health (PHRC n 20-0424); Stiftungsfonds zur F{\"o}rderung der Bek{\"a}mpfung der Tuberkulose und anderer Lungenkrankheiten of the City of Vienna, Project Number: APCOV22BGM; Italian Ministry of Health “Fondi Ricerca corrente–L1P6” to IRCCS Ospedale Sacro Cuore–Don Calabria; Australian Department of Health grant (3273191); Gender Equity Strategic Fund at University of Queensland, Artificial Intelligence for Pandemics (A14PAN) at University of Queensland, the Australian Research Council Centre of Excellence for Engineered Quantum Systems (CE170100009), the Prince Charles Hospital Foundation, Australia; Brazil, National Council for Scientific and Technological Development Scholarship number 303953/2018- 7; the Firland Foundation, Shoreline, Washington, USA; a grant from foundation Bevordering Onderzoek Franciscus; the South Eastern Norway Health Authority and the Research Council of Norway; Institute for Clinical Research, National Institutes of Health supported by the Ministry of Health Malaysia; grants from the National Institute for Health Research (NIHR; award CO-CIN-01), the Medical Research Council (grant MC_PC_19059), and by the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (award 200907), NIHR Health Protection Research Unit in Respiratory Infections at Imperial College London with Public Health England (award 200927), Liverpool Experimental Cancer Medicine Centre (grant C18616/A25153), NIHR Biomedical Research Centre at Imperial College London (award IS-BRC-1215-20013), and NIHR Clinical Research Network providing infrastructure support. M.J.G. received support through the Faculty Small Grant Program from the Vice President for Research of the University of Utah to fund statistical analysis. This project was supported by the University Research Committee and the Study Design and Biostatistics Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, Grant 8UL1TR000105 (formerly UL1RR025764)) at the University of Utah and by Universidad de La Sabana (MED-309-2021). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the University Research Committee, Vice President for Research Office, or University of Utah.",

year = "2023",

month = jul,

day = "1",

doi = "10.1016/j.rpth.2023.102142",

language = "English",

volume = "7",

journal = "Research and Practice in Thrombosis and Haemostasis",

issn = "2475-0379",

publisher = "Wiley-Blackwell",

number = "5",

}

ISARIC Clinical Characterisation Group, Griffee, MJ, Bozza, PT, Reyes, LF, Eddington, DP, Rosenberger, D, Merson, L, Citarella, BW, Fanning, JP, Alexander, PMA, Fraser, J, Dalton, H & Cho, S-M 2023, 'Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry', Research and Practice in Thrombosis and Haemostasis, vol. 7, no. 5, 102142. https://doi.org/10.1016/j.rpth.2023.102142

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry. / ISARIC Clinical Characterisation Group; Griffee, Matthew J.; Bozza, Patricia T. et al.
In: Research and Practice in Thrombosis and Haemostasis, Vol. 7, No. 5, 102142, 01.07.2023.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

AU - ISARIC Clinical Characterisation Group

AU - Griffee, Matthew J.

AU - Bozza, Patricia T.

AU - Reyes, Luis Felipe

AU - Eddington, Devin P.

AU - Rosenberger, Dorothea

AU - Merson, Laura

AU - Citarella, Barbara Wanjiru

AU - Fanning, Jonathon P.

AU - Alexander, Peta M.A.

AU - Fraser, John

AU - Dalton, Heidi

AU - Cho, Sung-Min

AU - Green, Christopher

N1 - Funding: This work was made possible by the UK Foreign, Commonwealth and Development Office and Wellcome (215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z and 220757/Z/20/Z); the Bill & Melinda Gates Foundation (OPP1209135); philanthropic support of the donors to the University of Oxford’s COVID-19 Research Response Fund (0009109); CIHR Coronavirus Rapid Research Funding Opportunity OV2170359 and coordination in Canada by Sunnybrook Research Institute; funding by the Health Research Board of Ireland (CTN-2014-12); Rapid European COVID-19 Emergency Response research (H2020 project 101003589) and European Clinical Research Alliance on Infectious Diseases (965313); the Research Council of Norway grant no 312780, and a philanthropic donation from Vivaldi Invest A/S owned by Jon Stephenson von Tetzchner; the Comprehensive Local Research Networks, of which PJMO is an NIHR Senior Investigator (NIHR201385); Innovative Medicines Initiative Joint Undertaking under Grant Agreement No. 115523 Combating Bacterial Resistance in Europe, the resources of which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007- 2013) and European Federation of Pharmaceutical Industries and Associations companies, in-kind contribution; the French COVID cohort (NCT04262921) is sponsored by INSERM and is funded by the REACTing (REsearch & ACtion emergING infectious diseases) consortium and by a grant of the French Ministry of Health (PHRC n 20-0424); Stiftungsfonds zur Förderung der Bekämpfung der Tuberkulose und anderer Lungenkrankheiten of the City of Vienna, Project Number: APCOV22BGM; Italian Ministry of Health “Fondi Ricerca corrente–L1P6” to IRCCS Ospedale Sacro Cuore–Don Calabria; Australian Department of Health grant (3273191); Gender Equity Strategic Fund at University of Queensland, Artificial Intelligence for Pandemics (A14PAN) at University of Queensland, the Australian Research Council Centre of Excellence for Engineered Quantum Systems (CE170100009), the Prince Charles Hospital Foundation, Australia; Brazil, National Council for Scientific and Technological Development Scholarship number 303953/2018- 7; the Firland Foundation, Shoreline, Washington, USA; a grant from foundation Bevordering Onderzoek Franciscus; the South Eastern Norway Health Authority and the Research Council of Norway; Institute for Clinical Research, National Institutes of Health supported by the Ministry of Health Malaysia; grants from the National Institute for Health Research (NIHR; award CO-CIN-01), the Medical Research Council (grant MC_PC_19059), and by the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (award 200907), NIHR Health Protection Research Unit in Respiratory Infections at Imperial College London with Public Health England (award 200927), Liverpool Experimental Cancer Medicine Centre (grant C18616/A25153), NIHR Biomedical Research Centre at Imperial College London (award IS-BRC-1215-20013), and NIHR Clinical Research Network providing infrastructure support. M.J.G. received support through the Faculty Small Grant Program from the Vice President for Research of the University of Utah to fund statistical analysis. This project was supported by the University Research Committee and the Study Design and Biostatistics Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, Grant 8UL1TR000105 (formerly UL1RR025764)) at the University of Utah and by Universidad de La Sabana (MED-309-2021). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the University Research Committee, Vice President for Research Office, or University of Utah.

PY - 2023/7/1

Y1 - 2023/7/1

N2 - Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs).Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality.Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions.Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51).Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings.

AB - Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs).Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality.Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions.Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51).Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings.

KW - COVID-19

KW - developing countries

KW - disseminated intravascular coagulation

KW - hemorrhage

KW - ischemic stroke

KW - SARS-CoV-2

KW - thromboembolism

KW - thrombosis

U2 - 10.1016/j.rpth.2023.102142

DO - 10.1016/j.rpth.2023.102142

M3 - Article

SN - 2475-0379

VL - 7

JO - Research and Practice in Thrombosis and Haemostasis

JF - Research and Practice in Thrombosis and Haemostasis

IS - 5

M1 - 102142

ER -

ISARIC Clinical Characterisation Group, Griffee MJ, Bozza PT, Reyes LF, Eddington DP, Rosenberger D et al. Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry. Research and Practice in Thrombosis and Haemostasis. 2023 Jul 1;7(5):102142. doi: 10.1016/j.rpth.2023.102142