Incidence and Outcomes of Clinically Significant Bleeding Events in Critically Ill Covid-19 Patients Receiving Therapeutic Dose Anticoagulants: A Retrospective Cohort Study (Interact Study)
Indian Journal of Critical Care Medicine
; 26:S83, 2022.
Article
in English
| EMBASE | ID: covidwho-2006370
ABSTRACT
Aim and background:
The high mortality associated with the thrombotic events in hospitalised COVID-19 patients resulted in the usage of anticoagulants in varying doses. Whether the high-dose anticoagulants have led to better outcomes or higher incidence of clinically significant bleeding events is still debatable.Objectives:
To find the incidence of clinically significant bleeding events in moderate to severe COVID-19 patients on therapeutic anticoagulation and the factors influencing these events. Materials andmethods:
In our retrospective, single-centre, cohort study of 155 critically ill COVID-19 patients we observed the incidence of clinically significant bleeding. Multivariate regression models were used to evaluate the association between anticoagulant regimen, coagulation, and inflammatory markers with the incidence of bleeding and thrombotic events.Results:
The incidence of Clinically Relevant Non-Major Bleeding (CRNMB) was 33.5% (26.17-41.46%,) and major bleeding was 9.03% (5.02-14.69%). The anticoagulation intensity at baseline had a very high odds of major bleeding when Enoxaparin and dual antiplatelet therapy were used together (adjusted OR of 434.09 [3.81-49502.95], p < 0.05). At admission, bleeders had a poorer P/F ratio with more patients on invasive ventilation. At the time of bleeding, the bleeders had a higher d-dimer, ferritin, CRP, and procalcitonin. The subhazard ratio (SHR) for death in bleeders was 3.35 (95% CI, 1.97-5.65;p < 0.001).Conclusion:
The incidence of bleeding in critically ill COVID-19 patients on therapeutic anticoagulation increases with the severity of the disease as well as with concurrent use of dual antiplatelets. Major bleeding may also contribute to higher mortality.
anticoagulant agent; D dimer; endogenous compound; enoxaparin; ferritin; procalcitonin; adult; adverse drug reaction; anticoagulation; bleeding; cohort analysis; conference abstract; controlled study; coronavirus disease 2019; critically ill patient; drug therapy; dual antiplatelet therapy; female; Horowitz index; human; human cell; incidence; invasive ventilation; major clinical study; male; mortality; outcome assessment; regression model; retrospective study; therapeutic dose; thrombosis
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Language:
English
Journal:
Indian Journal of Critical Care Medicine
Year:
2022
Document Type:
Article
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