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Bleeding risk by intensity of anticoagulation in critically ill patients with COVID-19: A retrospective cohort study

Rim Halaby1, Adam Cuker1,2, Jennifer Yui3

  • 1Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Journal of Thrombosis and Haemostasis : JTH
|March 28, 2021
PubMed

Insights

Critically ill COVID-19 patients had similar bleeding risks as those with other respiratory viral illnesses. However, higher intensity anticoagulation in COVID-19 patients increased major bleeding risk compared to standard prophylaxis.

Area of Science:

  • Critical care medicine
  • Infectious diseases
  • Pharmacology

Background:

  • Coronavirus disease 2019 (COVID-19) is associated with hypercoagulability.
  • Institutions have escalated anticoagulation for thrombosis prophylaxis in COVID-19 patients.
  • The bleeding risk associated with varying anticoagulation intensities in COVID-19 is not fully understood.

Purpose of the Study:

  • To compare the incidence of major bleeding in critically ill COVID-19 patients versus those with other respiratory viral illnesses (ORVI).
  • To assess the effect of anticoagulation intensity on bleeding risk in COVID-19 patients.

Main Methods:

  • Retrospective cohort study comparing major bleeding incidence in intensive care unit (ICU) patients with COVID-19 versus ORVI.
  • Analysis of anticoagulation intensity at ICU admission and as a time-varying covariate in COVID-19 patients.
  • Used inverse-probability treatment weighting and adjusted for bleeding risk factors.

Main Results:

  • The hazard ratio for major bleeding in COVID-19 patients relative to ORVI patients was 1.26 (95% CI: 0.86-1.86).
  • Therapeutic-intensity anticoagulation at ICU admission was associated with increased bleeding risk (aHR 1.55; 95% CI: 0.88-2.73).
  • When anticoagulation was time-varying, therapeutic intensity significantly increased bleeding risk (aHR 2.59; 95% CI: 1.20-5.57) compared to standard thromboprophylaxis.

Conclusions:

  • Critically ill COVID-19 patients exhibit a bleeding risk comparable to ORVI patients.
  • Therapeutic-intensity anticoagulation in COVID-19 patients, especially when adjusted for dose changes, is linked to a substantially higher risk of major bleeding than standard thromboprophylaxis.
Abstract

Keywords:
COVID-19anticoagulantscritical illnesshemorrhagethrombosis

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