tetano
Editor, Senior Moderator
J Thromb Haemost
. 2021 May 21.
doi: 10.1111/jth.15400. Online ahead of print.
Bleeding risk in hospitalized patients with COVID-19 receiving intermediate- or therapeutic doses of thromboprophylaxis
Pablo Demelo-Rodriguez[SUP] 1 [/SUP], Ana Isabel Farf?n-Sedano[SUP] 2 [/SUP], Jos? Mar?a Pedrajas[SUP] 3 [/SUP], Pilar Llamas[SUP] 4 [/SUP], Patricia Sig?enza[SUP] 5 [/SUP], Mar?a Jes?s Jaras[SUP] 6 [/SUP], Manuel Quintana-Diaz[SUP] 7 [/SUP], Carmen Fern?ndez-Capit?n[SUP] 8 [/SUP], Behnood Bikdeli[SUP] 9 10 [/SUP], David Jim?nez[SUP] 11 [/SUP], Manuel Monreal[SUP] 12 [/SUP], RIETE-BLEEDING Investigators
Affiliations
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 multivariate logistic regression to explore the risk factors associated with major bleeding.
Results: During the study period, 1,965 patients were enrolled. Of them, 1,347 (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%). Multivariate analysis showed increased risk for in-hospital major bleeding associated with D-dimer levels >10 times the upper normal range (hazard ratio
, 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.
Keywords: COVID-19; anticoagulants; death; hemorrhage; prognosis.
. 2021 May 21.
doi: 10.1111/jth.15400. Online ahead of print.
Bleeding risk in hospitalized patients with COVID-19 receiving intermediate- or therapeutic doses of thromboprophylaxis
Pablo Demelo-Rodriguez[SUP] 1 [/SUP], Ana Isabel Farf?n-Sedano[SUP] 2 [/SUP], Jos? Mar?a Pedrajas[SUP] 3 [/SUP], Pilar Llamas[SUP] 4 [/SUP], Patricia Sig?enza[SUP] 5 [/SUP], Mar?a Jes?s Jaras[SUP] 6 [/SUP], Manuel Quintana-Diaz[SUP] 7 [/SUP], Carmen Fern?ndez-Capit?n[SUP] 8 [/SUP], Behnood Bikdeli[SUP] 9 10 [/SUP], David Jim?nez[SUP] 11 [/SUP], Manuel Monreal[SUP] 12 [/SUP], RIETE-BLEEDING Investigators
Affiliations
- PMID: 34018658
- DOI: 10.1111/jth.15400
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 multivariate logistic regression to explore the risk factors associated with major bleeding.
Results: During the study period, 1,965 patients were enrolled. Of them, 1,347 (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%). Multivariate analysis showed increased risk for in-hospital major bleeding associated with D-dimer levels >10 times the upper normal range (hazard ratio
, 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.
Keywords: COVID-19; anticoagulants; death; hemorrhage; prognosis.