Abstract Number: PB0196
Meeting: ISTH 2021 Congress
Theme: COVID and Coagulation » COVID and Coagulation, Clinical
Background: COVID-19 is a prothrombotic infection but there is limited data on bleeding risks.
Aims: This study aims to identify bleeding and thrombosis rates in relationship to anticoagulants in ventilated COVID-19 patients at a community hospital from March 1, 2020 until Feb 1, 2021.
Methods: This study was approved by the Institutional Review Board. All ventilated COVID-19 patients were included. Data was gathered by electronic medical record review. Bleed events were classified by ISTH criteria. Thrombosis events included venous thrombosis/arterial thrombosis/MI/stroke. Anticoagulant/antiplatelet agents at the time of the bleed/thrombosis event, and percent of hospitalization spent on full anticoagulation were recorded. Bleeding/thrombosis rates according to duration/degree/type of anticoagulant were calculated.
Of 145 pts analyzed, bleeds occurred in 40/145(28%), (25/145(17%) major, 15/145(10%) minor) with 10/40(25%) bleeds contributing to cause of death. Of 73 patients who received full dose anticoagulation at some point during their hospitalization, 31/73(44%) had a bleeding event. Of patients who received full dose anticoagulants for 75-100% of their hospitalization: 8/21(38%) bled, 50-74%: 7/15(46%) bled, 25-49%: 8/14(53%) bled, 1-24%: 9/23(39%) bled. All patients who bled were on full anticoagulation at the time of the bleed. Of the 72 patients who never received full dose anticoagulation, 9/72(12%) bled. Multiple anticoagulants were involved in bleeding events (Figure 1). Of patients who bled, 14/40(35%) were also on antiplatelet agents. Site of bleed was predominantly pulmonary/tracheal (Figure 2). Indications for full anticoagulation were predominantly atrial fibrillation (14/31(45%) and pulmonary emboli (6/31(19%)). Thrombosis rates were 15%, with 16/21(76%) on prophylactic and 5/21(24%) on full anticoagulation.
Conclusions: Ventilated COVID-19 patients had rates of thromboses consistent with other critically ill patients, but bleed rates were extremely high with significant mortality. Pulmonary bleeds predominated. Bleeds occurred regardless of type of full anticoagulant. Bleeding was highly correlated with use but not duration of full dose anticoagulation. Anticoagulant decisions for COVID-19 patients remain challenging.
To cite this abstract in AMA style:
Tassava T, Callahan C, Mayo M, Bzeih R. Bleeding in Critically Ill Patients with COVID-19 [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/bleeding-in-critically-ill-patients-with-covid-19/. Accessed March 21, 2024.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/bleeding-in-critically-ill-patients-with-covid-19/