ABSTRACT
Background: COVID-19 patients are at increased risk of venous thromboembolism (VTE) requiring the use of anticoagulation. Gastrointestinal bleeding (GIB) is increasingly being reported, complicating the decision to initiate or resume anticoagulation as providers balance the risk of thrombotic disease with the risk of bleeding. Aim: Our primary aim is to assess rebleeding rates in COVID-19 patients with GIB and determine whether endoscopic evaluation and anticoagulation use affects these rates. Our secondary aim is to determine the 30-day VTE and mortality rates in this cohort. Methods: This is a retrospective study that reviewed 56 cases of COVID-19 patients with GIB admitted to the hospital between March 4th – May 25th. All patients tested positive for COVID 19 with reverse transcriptase polymerase chain reaction nasopharyngeal swabs. The cases were reviewed for the following outcomes: rates of therapeutic intervention, 30-day rebleeding, 30-day VTE events and 30-day mortality. Results: 23/56 (41%) of COVID-19 patients with GIB rebled within 30 days. There was no reduction in rebleeding rate with endoscopic therapy compared to medical management alone (39% vs. 42%, p=0.81). There was no difference in 30 day rebleeding rate among patients restarted on anticoagulation after endoscopy compared to those that were restarted on anticoagulation after medical management alone (41% vs 29%, p = 0.47). 15/56 (27%) of the cohort had VTE during their hospitalization, 53% of which were diagnosed after anticoagulation was held due to GIB. Patients that undergone endoscopy were more likely to be initiated or resumed on anticoagulation after bleed then those that did not (87% vs 55%, p=0.02). The all-cause 30-day mortality and GI-bleeding related deaths were 32% and 9% respectively. There was no difference in 30 day mortality rate among patients that were restarted on anticoagulation after endoscopic management compared to those restarted on anticoagulation after conservative management alone (24% vs 29%, p=0.70). Conclusions: In this cohort, while there was no difference in rebleeding rate when comparing endoscopic therapy to conservative management, patients who underwent endoscopy were more likely to be restarted on anticoagulation. Given that there was no difference in rebleeding or mortality rates among those restarted on anticoagulation after endoscopy compared to patients that were restarted on anticoagulation after conservative management, it seems reasonable to re-challenge COVID-19 patients who have stopped bleeding with anticoagulation even if endoscopy cannot be performed. However, larger studies are needed to guide management of these complex patients.(Table Presented) (Table Presented)