[Laboratory predictors of bleeding development during anticoagulant prophylaxis of venous thromboembolic...

Identifying patients at high risk of bleeding currently remains an important problem in real clinical practice, which was most clearly evident after the pandemic of the coronavirus infection.

To evaluate the significance of laboratory predictors in determining the risk of the development of hemorrhagic complications during anticoagulant prevention of venous thromboembolic complications.

Our prospective observational study included a total of 370 patients divided into three groups: Group 1 comprising 190 subjects using low-molecular-weight heparin (LMWH), Group 2 composed of 123 patients receiving unfractionated heparin (UFH), and Group 3 consisting of 57 people constantly taking direct oral anticoagulants (DOACs). In each Group, we assessed the incidence of hemorrhagic complications and the laboratory parameters when elevated causing them.

It was determined that the main clinical factors of bleeding development were as follows: obesity (OR 3.225; 95% CI 1.275-8.16; p=0.013), chronic venous insufficiency (OR: 2.889, 95% CI: 1.039-8.034, p=0.042), and a history of VTEC (OR 5.694; 95% CI 1.69-19.187; p=0.005). Analyzing the laboratory data demonstrated that initially high values of leukocytes (OR 1.043; 95% CI 1.003-1.084; p=0.035) and ferritin (OR 1.002; 95% CI 1.0003-1.004, p=0.028) against the background of the anticoagulant therapy contributed to the development of bleeding. And on the contrary, high values of specific markers of inflammation and thrombosis at the beginning of anticoagulant treatment did not indicate the possible development of hemorrhagic complications.

The laboratory parameters possessing prognostic significance for predicting bleeding were found to be high concentrations of leukocytes and ferritin, as well as low levels of fibrinogen and high levels of D-dimer.