“Prevalence, Predictors and Outcomes of Surgical and Gastrointestinal Bleeding Events in Patients with COVID-19 Infection on Anticoagulation”

Abstract

\n BackgroundThis study aims to examine risk factors and complications associated with bleeding events in patients with coronavirus 19 (COVID-19) who are on anticoagulation. MethodWe conducted retrospective review of a prospectively maintained database of all patients who were admitted with COVID-19 and developed bleeding events. ResultsOf 122 bleeds, there were 67 (28%) non-gastrointestinal (GI) and 55 (28%) GI bleeds. Overall mortality was 59% (n= 72), 34 (28%) and 38 (31%) following non-GI and GI bleeds respectively. The prevalence of therapeutic invasive interventions was 7.5% and 16.3% in non-GI and GI bleeds respectively and all were successful in resolving the bleeding event. We found that having a GI bleeds was associated with higher risk of mortality compared to non-GI bleeds (p= 0.04) and having occult bleeds to be associated with 15 times increased risk of mortality. Furthermore, patients who were on therapeutic dose of anticoagulation were more likely to die compared to patients who were on none (odds ratio (OR) 0.1, 95%CI 0.01-0.86), on prophylactic (OR 0.07,95%CI 0.02-0.28) or intermediate (OR 0.36,95%CI 0.09-1.34) anticoagulation doses.Conclusions Routine prescription of supra-prophylactic dose anticoagulation should be revisited as it appears to be associated with increased of mortality and so more individualized approach to prescription should be the norm. Regardless of the cause of bleeding event it appears that the majority of bleeding events resolve with noninvasive interventions, correction and optimization sepsis therapies. However, when invasive interventions were necessary, they were associated with high success rate despite the delay.