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Major hemorrhage and mortality in COVID-19 patients on therapeutic anticoagulation for venous thromboembolism.
Prince, Martin R; Dev, Hreedi; Lane, Elizabeth G; Margolis, Daniel J; DeSancho, Maria T.
  • Prince MR; Department of Radiology, Weill Cornell Medicine, 416 East 55th Street, New York, NY, 10022, USA. map2008@med.cornell.edu.
  • Dev H; Department of Radiology, Columbia University, New York, USA. map2008@med.cornell.edu.
  • Lane EG; Department of Radiology, Weill Cornell Medicine, 416 East 55th Street, New York, NY, 10022, USA.
  • Margolis DJ; Department of Radiology, Weill Cornell Medicine, 416 East 55th Street, New York, NY, 10022, USA.
  • DeSancho MT; Department of Radiology, Weill Cornell Medicine, 416 East 55th Street, New York, NY, 10022, USA.
J Thromb Thrombolysis ; 54(3): 431-437, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1885483
ABSTRACT
We observed multiple fatal intracranial hemorrhages shortly after initiating therapeutic anticoagulation for treatment of venous thromboembolism (VTE) in COVID-19 patients suggesting increased anticoagulation risk associated with COVID-19. The objective of this study is to quantify risk of major hemorrhage in hospitalized COVID-19 patients on therapeutic anticoagulation for deep venous thrombosis (DVT) or pulmonary embolism (PE). Hospitalized patients with COVID-19 receiving therapeutic anticoagulation for DVT, PE or both at four New York City hospitals were evaluated for hemorrhagic complications. These were categorized as major (including fatal) or clinically relevant non-major according to the criteria of the International Society of Thrombosis and Haemostasis. Hemorrhagic complications were correlated with clinical and laboratory data, ICD-10 code diagnoses and type of anticoagulation treatment. Minor hemorrhages were excluded. Major/clinically relevant hemorrhages occurred in 36 of 170 (21%) hospitalized COVID-19 patients being treated with therapeutic anticoagulation for VTE including 4 (2.4%) fatal hemorrhages. Hemorrhage was 3.4 times more likely with unfractionated heparin 27/76 (36%) compared to 8/81 (10%) with low molecular weight heparin (p = 0.002). Multivariate analysis showed that major hemorrhage was associated with intubation (p = 0.04) and elevated serum LDH (p < 0.001) and low fibrinogen (p = 0.05). Increased risk of hemorrhagic complications in treating VTE in hospitalized COVID-19 patients should be considered especially when using unfractionated heparin, in intubated patients, with low fibrinogen and/or elevated LDH. Checking serum fibrinogen and LDH before initiating therapeutic anticoagulation and monitoring coagulation parameters frequently may reduce bleeding complications.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pulmonary Embolism / Venous Thromboembolism / COVID-19 / COVID-19 Drug Treatment Type of study: Diagnostic study / Experimental Studies / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: J Thromb Thrombolysis Journal subject: Vascular Diseases Year: 2022 Document Type: Article Affiliation country: S11239-022-02666-w

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pulmonary Embolism / Venous Thromboembolism / COVID-19 / COVID-19 Drug Treatment Type of study: Diagnostic study / Experimental Studies / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: J Thromb Thrombolysis Journal subject: Vascular Diseases Year: 2022 Document Type: Article Affiliation country: S11239-022-02666-w