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Vol. 47. Issue 1.
Pages 1-8 (January 2023)
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Vol. 47. Issue 1.
Pages 1-8 (January 2023)
Original article
Anticoagulation strategies and risk of bleeding events in critically ill COVID-19 patients
Estrategias de anticoagulación y riesgo de sangrado en pacientes ingresados en una Unidad de Cuidados Intensivos por COVID-19
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C. Gabaraa, B. Solaratb, P. Castroa,c, S. Fernándeza,c, J.R. Badiab, D. Toapantad, S. Schulmane,f, J.C. Reverterg, A. Sorianoh, J. Moisésb,1,
Corresponding author
jrmoises@clinic.cat

Corresponding author.
, J. Aibara,1,2
a Internal Medicine Department, Hospital Clínic, IDIBAPS – University of Barcelona, Spain
b Pneumology Department, Hospital Clínic, IDIBAPS – University of Barcelona, Spain
c Medical Intensive Care Unit, Hospital Clínic, IDIBAPS – University of Barcelona, Spain
d Liver ICU, Hospital Clínic, IDIBAPS – University of Barcelona, Spain
e Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
f Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
g Hematology Department, Hospital Clínic, IDIBAPS – University of Barcelona, Spain
h Infectious Disease Department, Hospital Clínic, IDIBAPS – University of Barcelona, Spain
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Abstract
Objective

To evaluate the rate of thrombosis, bleeding and mortality comparing anticoagulant doses in critically ill COVID-19 patients.

Design

Retrospective observational and analytical cohort study.

Setting

COVID-19 patients admitted to the intensive care unit of a tertiary hospital between March and April 2020.

Patients

201 critically ill COVID-19 patients were included. Patients were categorized into three groups according to the highest anticoagulant dose received during hospitalization: prophylactic, intermediate and therapeutic.

Interventions

The incidence of venous thromboembolism (VTE), bleeding and mortality was compared between groups. We performed two logistic multivariable regressions to test the association between VTE and bleeding and the anticoagulant regimen.

Main variables of interest

VTE, bleeding and mortality.

Results

78 patients received prophylactic, 94 intermediate and 29 therapeutic doses. No differences in VTE and mortality were found, while bleeding events were more frequent in the therapeutic (31%) and intermediate (15%) dose group than in the prophylactic group (5%) (p<0.001 and p<0.05 respectively). The anticoagulant dose was the strongest determinant for bleeding (odds ratio 2.4, 95% confidence interval 1.26–4.58, p=0.008) but had no impact on VTE.

Conclusions

Intermediate and therapeutic doses appear to have a higher risk of bleeding without a decrease of VTE events and mortality in critically ill COVID-19 patients.

Keywords:
COVID-19
Critical care
Thrombosis
Bleeding
Anticoagulation
Resumen
Objetivo

Evaluar la incidencia de eventos trombóticos, sangrado y mortalidad comparando diferentes regímenes de anticoagulación en pacientes ingresados en unidades de Cuidados Intensivos (UCI) por COVID-19.

Diseño

Estudio de cohortes retrospectivo observacional y analítico.

Ámbito

Pacientes con COVID-19 ingresados en una UCI de un hospital terciario entre marzo y abril del 2020.

Pacientes

Se incluyó a un total de 201 pacientes de UCI ingresados por COVID-19. Los pacientes se categorizaron en 3 grupos en función de la dosis de anticoagulación más alta recibida durante el ingreso: profiláctica, intermedia y terapéutica.

Intervenciones

Se comparó la incidencia de eventos trombóticos, hemorragia y mortalidad entre los grupos. Se realizaron 2 regresiones logísticas multivariables para comprobar la asociación entre los eventos trombóticos y el sangrado con el régimen anticoagulante.

Principales variables de interés

Eventos trombóticos, sangrado y mortalidad.

Resultados

De los pacientes incluidos, 78 recibieron dosis profilácticas, 94 intermedias y 29 terapéuticas. No se encontraron diferencias en los eventos trombóticos y la mortalidad entre grupos, mientras que los sangrados fueron más frecuentes en el grupo de dosis terapéutica (31%) e intermedia (15%) que en el grupo de dosis profiláctica (5%) (p <0,001 y p <0,05, respectivamente). El régimen anticoagulante fue el mayor determinante de sangrado (odds ratio 2,4;, intervalo de confianza del 95%, 1,26-4,58; p=0,008) pero no tuvo ningún impacto en los eventos trombóticos.

Conclusiones

Las dosis intermedias y terapéuticas parecen tener un mayor riesgo de sangrado sin una disminución de los eventos trombóticos ni la mortalidad en pacientes de UCI con COVID-19.

Palabras clave:
COVID-19
Cuidados intensivos
Trombosis
Sangrado
Anticoagulación

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