Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
J Thromb Haemost. 2021 Jun;19(6):1533-1545. doi: 10.1111/jth.15310. Epub 2021 May 7.
Studies report hypercoagulability in coronavirus disease 2019 (COVID-19), leading many institutions to escalate anticoagulation intensity for thrombosis prophylaxis.
To determine the bleeding risk with various intensities of anticoagulation in critically ill patients with COVID-19 compared with other respiratory viral illnesses (ORVI).
PATIENTS/METHODS: This retrospective cohort study compared the incidence of major bleeding in patients admitted to an intensive care unit (ICU) within a single health system with COVID-19 versus ORVI. In the COVID-19 cohort, we assessed the effect of anticoagulation intensity received on ICU admission on bleeding risk. We performed a secondary analysis with anticoagulation intensity as a time-varying covariate to reflect dose changes after ICU admission.
Four hundred and forty-three and 387 patients were included in the COVID-19 and ORVI cohorts, respectively. The hazard ratio of major bleeding for the COVID-19 cohort relative to the ORVI cohort was 1.26 (95% confidence interval [CI]: 0.86-1.86). In COVID-19 patients, an inverse-probability treatment weighted model found therapeutic-intensity anticoagulation on ICU admission had an adjusted hazard ratio of bleeding of 1.55 (95% CI: 0.88-2.73) compared with standard prophylactic-intensity anticoagulation. However, when anticoagulation was assessed as a time-varying covariate and adjusted for other risk factors for bleeding, the adjusted hazard ratio for bleeding on therapeutic-intensity anticoagulation compared with standard thromboprophylaxis was 2.59 (95% CI: 1.20-5.57).
Critically ill patients with COVID-19 had a similar bleeding risk as ORVI patients. When accounting for changes in anticoagulation that occurred in COVID-19 patients, therapeutic-intensity anticoagulation was associated with a greater risk of major bleeding compared with standard thromboprophylaxis.
研究报告称，2019 年冠状病毒病（COVID-19）存在高凝状态，这导致许多机构提高了抗凝强度以预防血栓形成。
与其他呼吸道病毒感染（ORVI）相比，确定 COVID-19 重症患者接受不同强度抗凝治疗的出血风险。
患者/方法：这项回顾性队列研究比较了单一医疗系统中入住重症监护病房（ICU）的 COVID-19 患者与 ORVI 患者的主要出血发生率。在 COVID-19 队列中，我们评估了 ICU 入院时接受的抗凝强度对出血风险的影响。我们使用抗凝强度作为时变协变量进行了二次分析，以反映 ICU 入院后剂量的变化。
COVID-19 队列和 ORVI 队列分别纳入了 443 例和 387 例患者。COVID-19 队列的主要出血风险比 ORVI 队列高 1.26（95%置信区间[CI]：0.86-1.86）。在 COVID-19 患者中，逆概率治疗加权模型发现，与标准预防强度抗凝相比，ICU 入院时进行治疗强度抗凝的出血调整后危险比为 1.55（95%CI：0.88-2.73）。然而，当将抗凝作为时变协变量进行评估并调整出血的其他危险因素时，与标准抗血栓形成治疗相比，治疗强度抗凝的出血调整后危险比为 2.59（95%CI：1.20-5.57）。
COVID-19 重症患者的出血风险与 ORVI 患者相似。当考虑 COVID-19 患者抗凝治疗的变化时，与标准抗血栓形成治疗相比，治疗强度抗凝与主要出血风险增加相关。
