Bleeding risk in hospitalized patients with COVID‐19 receiving intermediate‐ or therapeutic doses of thromboprophylaxis. (20th June 2021)

• Record Type: Journal Article
• Authors: Demelo‐Rodriguez, Pablo; Farfán‐Sedano, Ana Isabel; Pedrajas, José María; Llamas, Pilar; Sigüenza, Patricia; Jaras, María Jesús; Quintana‐Diaz, Manuel; Fernández‐Capitán, Carmen; Bikdeli, Behnood; Jiménez, David; Monreal, Manuel
• Other Names: D Adarraga investigator.; J Aibar investigator.; C Baeza investigator.; A Ballaz investigator.; R Barba investigator.; A Blanco‐Molina investigator.; E Botella investigator.; J Criado investigator.; P Demelo‐Rodríguez investigator.; AM Díaz‐Brasero investigator.; C de Ancos investigator.; J del Toro investigator.; AI Farfán‐Sedano investigator.; C Fernández‐Capitán investigator.; A Fidalgo investigator.; K Flores investigator.; C Gabara investigator.; F Galeano‐Valle investigator.; O Gavín‐Sebastián investigator.; A Gil‐Díaz investigator.; MJ Jaras investigator.; L Jara‐Palomares investigator.; R Jiménez investigator.; S Lainez‐Justo investigator.; A Latorre investigator.; R Lecumberri investigator.; P Llamas investigator.; JL Lobo investigator.; L López‐Jiménez investigator.; B Loureiro investigator.; O Madridano investigator.; AB Mancebo‐Plaza investigator.; M Martín del Pozo investigator.; M Monreal investigator.; N Muñoz‐Rivas investigator.; MJ Núñez‐Fernández investigator.; PE Olivera investigator.; L Ordieres‐Ortega investigator.; EM Padín‐Paz investigator.; JM Pedrajas investigator.; M Quintana‐Díaz investigator.; M Ríos‐Prego investigator.; DA Rodríguez‐Chiaradía investigator.; P Ruiz‐Artacho investigator.; P Sigüenza investigator.; JM Suriñach investigator.; J Trujillo‐Santos investigator.; C Zamora investigator.; E Bucherini investigator.; P Di Micco investigator.; E Imbalzano investigator.; C Siniscalchi investigator.; M Bosevski investigator.; M Stevanovic investigator.; L Paz‐Rios investigator.; I Weinberg investigator.;
• Is Part Of: Journal of thrombosis and haemostasis. Volume 19:Number 8(2021)
• Page Start: 1981
• Page End: 1989
• Publication Date: 2021-06-20
• Subjects: anticoagulants -- COVID‐19 -- death -- hemorrhage -- prognosis; Thrombosis -- Periodicals; Hemostasis -- Periodicals; Blood coagulation disorders -- Periodicals; 616.1
• DOI: 10.1111/jth.15400
• Languages: English
• ISSNs: 1538-7933

Abstract

Abstract: Introduction: Some local protocols suggest using intermediate or therapeutic doses of anticoagulants for thromboprophylaxis in hospitalized patients with coronavirus disease 2019 (COVID‐19). However, the incidence of bleeding, predictors of major bleeding, or the association between bleeding and mortality remain largely unknown. Methods: We performed a cohort study of patients hospitalized for COVID‐19 that received intermediate or therapeutic doses of anticoagulants from March 25 to July 22, 2020, to identify those at increased risk for major bleeding. We used bivariate and multivariable logistic regression to explore the risk factors associated with major bleeding. Results: During the study period, 1965 patients were enrolled. Of them, 1347 (69%) received intermediate‐ and 618 (31%) therapeutic‐dose anticoagulation, with a median duration of 12 days in both groups. During the hospital stay, 112 patients (5.7%) developed major bleeding and 132 (6.7%) had non‐major bleeding. The 30‐day all‐cause mortality rate for major bleeding was 45% (95% confidence interval [CI]: 36%‐54%) and for non‐major bleeding 32% (95% CI: 24%‐40%). Multivariable analysis showed increased risk for in‐hospital major bleeding associated with D‐dimer levels >10 times the upper normal range (hazard ratio [HR], 2.23; 95% CI, 1.38–3.59), ferritin levels >500 ng/ml (HR, 2.01; 95% CI, 1.02–3.95), critical illness (HR, 1.91; 95% CI, 1.14–3.18), and therapeutic‐intensity anticoagulation (HR, 1.43; 95% CI, 1.01–1.97). Conclusions: Among patients hospitalized with COVID‐19 receiving intermediate‐ or therapeutic‐intensity anticoagulation, a major bleeding event occurred in 5.7%. Use of therapeutic‐intensity anticoagulation, critical illness, and elevated D‐dimer or ferritin levels at admission were associated with increased risk for major bleeding.