Journal article
Bleeding risk by intensity of anticoagulation in critically ill patients with COVID-19: A retrospective cohort study
JOURNAL OF THROMBOSIS AND HAEMOSTASIS, v 19(6), pp 1533-1545
Jun 2021
PMID: 33774903
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background Studies report hypercoagulability in coronavirus disease 2019 (COVID-19), leading many institutions to escalate anticoagulation intensity for thrombosis prophylaxis. Objective To determine the bleeding risk with various intensities of anticoagulation in critically ill patients with COVID-19 compared with other respiratory viral illnesses (ORVI). Patients/Methods This retrospective cohort study compared the incidence of major bleeding in patients admitted to an intensive care unit (ICU) within a single health system with COVID-19 versus ORVI. In the COVID-19 cohort, we assessed the effect of anticoagulation intensity received on ICU admission on bleeding risk. We performed a secondary analysis with anticoagulation intensity as a time-varying covariate to reflect dose changes after ICU admission. Results Four hundred and forty-three and 387 patients were included in the COVID-19 and ORVI cohorts, respectively. The hazard ratio of major bleeding for the COVID-19 cohort relative to the ORVI cohort was 1.26 (95% confidence interval [CI]: 0.86-1.86). In COVID-19 patients, an inverse-probability treatment weighted model found therapeutic-intensity anticoagulation on ICU admission had an adjusted hazard ratio of bleeding of 1.55 (95% CI: 0.88-2.73) compared with standard prophylactic-intensity anticoagulation. However, when anticoagulation was assessed as a time-varying covariate and adjusted for other risk factors for bleeding, the adjusted hazard ratio for bleeding on therapeutic-intensity anticoagulation compared with standard thromboprophylaxis was 2.59 (95% CI: 1.20-5.57). Conclusions Critically ill patients with COVID-19 had a similar bleeding risk as ORVI patients. When accounting for changes in anticoagulation that occurred in COVID-19 patients, therapeutic-intensity anticoagulation was associated with a greater risk of major bleeding compared with standard thromboprophylaxis.
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Details
- Title
- Bleeding risk by intensity of anticoagulation in critically ill patients with COVID-19: A retrospective cohort study
- Publication Details
- JOURNAL OF THROMBOSIS AND HAEMOSTASIS, v 19(6), pp 1533-1545
- Publisher
- WILEY; HOBOKEN
- Number of pages
- 12
- Grant note
- Hemostasis and Thrombosis Research Society, Grant/Award Number: Mentored Research Award supported by Sanofi Genzym; Penn Cardiovascular Disease Fellowship Innovation Fund
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Drexel University
- Web of Science ID
- WOS:000648142500001
- Scopus ID
- 2-s2.0-85105315183
- Other Identifier
- 991021860757404721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Hematology
- Peripheral Vascular Disease