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Major Bleeding Events in Hospitalized COVID-19 Patients: A Retrospective Observational Study
Andrea Poloni1,2, Giacomo Casalini2, Giacomo Pozza1,2
1Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20122 Milan, Italy.
Insights
Major bleeding events occurred in 0.98% of hospitalized COVID-19 patients, with older age being a significant risk factor. Strict monitoring is crucial for elderly COVID-19 patients receiving anticoagulation therapy.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Cardiology
Background:
- Hospitalized COVID-19 patients often require thromboprophylaxis or anticoagulation.
- Major bleeding is a significant concern in patients receiving anticoagulant therapy.
Purpose of the Study:
- To estimate the prevalence of major bleeding events in hospitalized COVID-19 patients.
- To identify factors associated with major bleeding events in this population.
Main Methods:
- Retrospective observational study of COVID-19 patients (≥18 years) at a reference center in northern Italy (February 2020-2022).
- Prevalence calculated as major bleeding episodes divided by patients at risk.
- Univariable and multivariable Cox models used to assess risk factors.
Main Results:
- A total of 2,945 patients were included; 29 (0.98%) experienced a major bleeding event (prevalence 0.55%).
- Five bleeding events were fatal.
- Patients with major bleeding were older (median 78 vs. 67 years) and more often received anti-aggregating therapy (44.8% vs. 20.0%).
- Increased age was independently associated with a higher risk of major bleeding (AHR 1.05 per year).
Conclusions:
- The prevalence of major bleeding events in hospitalized COVID-19 patients is relatively low but significant.
- Older age is a key independent risk factor for major bleeding in this cohort.
- Close monitoring of older hospitalized COVID-19 patients is recommended to mitigate bleeding risks.
Abstract:
Thromboprophylaxis/anticoagulation treatment is often required in hospitalized COVID-19 patients. We aimed to estimate the prevalence of major bleeding events in hospitalized COVID-19 patients. This was a retrospective observational study including all COVID-19 hospitalized patients ≥18 years of age at one reference center in northern Italy. The crude prevalence (between February 2020-2022) of major bleeding events was estimated as the number of major bleeding episodes divided by patients at risk. Uni- and multivariable Cox models were built to assess factors potentially associated with major bleeding events. Twenty-nine (0.98%) out of 2,945 COVID-19 patients experienced a major bleeding event [prevalence of 0.55% (95%CI 0.37-0.79)], of which five were fatal. Patients who experienced a major bleeding event were older [78 years (72-84 IQR) vs. 67 years (55-78 IQR), p-value < 0.001] and more frequently exposed to anti-aggregating therapy (44.8% vs. 20.0%, p-value 0.002) when compared to those who did not. In the multivariable Cox model, age [per 1 year more AHR 1.05 (CI95% 1.02-1.09)] was independently associated with an increased risk of major bleeding events. A strict monitoring of older hospitalized COVID-19 patients is warranted due to the risk of major bleeding events.
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