ABSTRACT
INTRODUCTION: Coronavirus disease 2019 (COVID-19) can be associated with coagulopathy and a high incidence of thromboembolic events. These events were associated with worse clinical outcomes, especially in critically ill patients. Our study investigated the safety of full dose anticoagulation (AC), in ventilated, predominantly Black patients with COVID-19 infection. METHODS: This is a retrospective observational study based on a chart review of patients admitted to the University Hospital of Brooklyn in New York City from March 23rd through April 23rd, 2020. Inclusion criteria included age ≥ 18 years, confirmed COVID-19 infection, and need for mechanical ventilation. The variables collected included demographics, comorbidities, laboratory results, type of anticoagulation, and Sepsis- Induced Coagulopathy (SIC) score RESULTS: A total of 48 hospitalized patients met the inclusion criteria. 41 (85.4%) were Black, 26 (54%) were males, 22 (46%) were females, and the average age was 68 years. Average days on mechanical ventilation was 13.6 days. D-Dimer was elevated in all patients, with an average of 5.8 mcg/ml. Almost all patients (47/48) had elevated SIC score, defined as SIC score of 2 or above. AC agent used was Heparin in 13 patients (27.1%), low molecular weight heparin (LMWH) in 12 (25%), direct oral anticoagulants (DOAC) in 8 (16.7%), and multiple AC agents in 15 (31.3%). AC was stopped because of major bleed in 5 patients. Overall mortality was 62.5%. AC discontinuation was not associated with increased overall mortality (Pearson Chi-Square= 0.228;p=0.633) CONCLUSIONS: Our study showed that full dose anticoagulation was administered in high risk ICU patients with COVID-19 infection, and significantly elevated D-Dimer level and SIC score. Most patients received heparin or LMWH, or a combination of heparin products with transition to DOAC. However only 5 patients had a major bleed, that was not a significant contributor to overall mortality. Based on our results, administration of full dose anticoagulation in ventilated predominantly black patients with COVID-19 infection, was overall safe and well tolerated.