Thrombotic Events and Anticoagulation-Related Bleeding Complications in Critically Ill Patients with Coronavirus...

Area of Science:

• Critical Care Medicine
• Hematology
• Infectious Diseases

Background:

• Thrombosis is a frequent complication in coronavirus disease 2019 (COVID-19) patients, with d-dimer levels correlating to outcomes.
• The role of anticoagulation (AC) in managing COVID-19 patients remains a subject of debate.
• This study evaluated a full-heparinization AC protocol implemented at the pandemic's onset.

Purpose of the Study:

• To assess the safety and efficacy of a full-heparinization anticoagulation protocol in critically ill COVID-19 patients.
• To determine if thrombosis (T) or bleeding (B) events predicted mortality in this cohort.
• To investigate factors associated with mortality in COVID-19 critical illness.

Main Methods:

• Prospective evaluation of 111 critically ill COVID-19 patients from March to June 2020.
• All patients received therapeutic heparinoid-based AC from admission.
• Incidences of T, B, or both (BT) were recorded; mortality was the primary outcome. Statistical analyses included Kruskal-Wallis test and logistic regression.

Main Results:

• Thirty-two percent (28%) experienced T, 20% had B, and 12% had both T and B (BT).
• Neither T, B, nor male gender predicted mortality in logistic regression models.
• Higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, elevated d-dimer concentrations, and increased activated partial thromboplastin time (aPTT) were associated with increased odds of death.

Conclusions:

• Thrombosis and bleeding events did not predict mortality in this cohort of critically ill COVID-19 patients receiving full-dose anticoagulation.
• The findings support the continued use of full-dose heparinoid prophylaxis in critically ill COVID-19 patients.
• This approach may be a safe and effective strategy for managing thrombotic risks in this population.