Bleeding prevalence in COVID-19 patients receiving intensive antithrombotic prophylaxis

Kessler, Chiara; Stricker, Hans; Demundo, Daniela; Elzi, Luigia; Monotti, Rita; Bianchi, G.; Llamas, Michael; Spinedi, Luca; Rossi, Davide; Chiesa, Alessandro; Pagnamenta, Alberto; Conti, Marco; Casso, Gabrièle; Stoira, Elisa; Valenti, Elisa; Colucci, Giuseppe; Stüssi, Georg; Gerber, Bernhard; Previsdomini, Marco

doi:10.1007/s11239-020-02244-y

Cited by 15 publications

(20 citation statements)

References 14 publications

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“…In our experience, bleeding on heparin occurred within the first 3 days or after 7 days of UFH infusion in patients who are COVID‐19 positive. This is consistent with recent data that showed major bleeding in patients with COVID‐19 receiving intensive prophylaxis occurred after the first 10 to 14 days of therapy 49 and may be explained by worsening illness severity, higher likelihood of multiorgan failure, or need for procedures in patients with prolonged critical illness.…”

Section: Discussionsupporting

confidence: 92%

“…This is consistent with published accounts indicating that while spontaneous bleeding events do occur in patients who are COVID‐19 positive such as diffuse alveolar hemorrhage 45 and microthrombosis‐associated 46 hemorrhage, bleeding in COVID‐19 is most often in the context of prophylactic 12,47 and therapeutic 47,48 anticoagulation. Our results are also consistent with data from other centers that have noted high rates of bleeding among patients with COVID‐19 receiving therapeutic anticoagulation 49 . In our experience, bleeding on heparin occurred within the first 3 days or after 7 days of UFH infusion in patients who are COVID‐19 positive.…”

Section: Discussionsupporting

confidence: 91%

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Management of therapeutic unfractionated heparin in COVID‐19 patients: A retrospective cohort study

Weeks

Sylvester

Connors

et al. 2021

Research and Practice in Thrombosis and Haemostasis

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

Management of therapeutic unfractionated heparin in COVID‐19 patients: A retrospective cohort study

Weeks

Sylvester

Connors

et al. 2021

Research and Practice in Thrombosis and Haemostasis

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“…Nonetheless, two recent observational studies suggested that this intensive thromboprophylaxis is safe in terms of inducing major bleeding events. 39,40 Thus, we believe that the intensive thromboprophylaxis protocol suggested by Stessel et al is a valid chemoprophylaxis regimen until further data from ongoing RCTs becomes available. 21…”

Section: Discussionmentioning

confidence: 97%

Prevalence of Venous Thromboembolism in Critically-ill COVID-19 Patients: Systematic Review and Meta-analysis

Mohamed

Al-Shokri

Shunnar

et al. 2020

Preprint

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Background: Recent studies revealed a high prevalence of venous thromboembolism (VTE) events in coronavirus disease 2019 (COVID-19) patients, especially in those who are critically ill. Available studies report varying prevalence rates. Hence, the exact prevalence remains uncertain. Moreover, there is an ongoing debate regarding the appropriate dosage of thromboprophylaxis. Methods: We performed a systematic review and proportion meta-analysis following PRISMA guidelines. We searched PubMed and EMBASE for studies exploring the prevalence of VTE in critically ill COVID-19 patients till 22/07/2020. We pooled the proportion of VTE. Additionally, in a subgroup analysis, we pooled VTE events detected by systematic screening. Finally, we compared the odds of VTE in patients on prophylactic compared to therapeutic anticoagulation. Results: The review comprised of 24 studies and over 2500 patients. The pooled proportion of VTE prevalence was 0.31 (95% CI 0.24, 0.39 I2 94%), of VTE utilizing systematic screening was 0.48 (95% CI 0.33, 0.63 I2 91%), of deep-venous-thrombosis was 0.23 (95% CI 0.14, 0.32 I2 96%), of pulmonary embolism was 0.14 (95% CI 0.09, 0.20 I2 90%). In a subgroup of studies, utilizing systematic screening, VTE risk increased significantly with prophylactic, compared to therapeutic anticoagulation (OR 5.45; 95% CI 1.90, 15.57 I2 0%). Discussion: Our review revealed a high prevalence of VTE in critically ill COVID-19 patients. Almost 50% of patients had VTE detected by systematic screening. Higher thromboprophylaxis dosages seem to reduce VTE burden in this patient's cohort compared to standard prophylactic anticoagulation; ongoing randomized controlled trials will further confirm this.

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“…The safety of intensive thromboprophylaxis was not addressed in our review due to data paucity. Nonetheless, two recent observational studies suggested that this intensive thromboprophylaxis is safe in terms of inducing major bleeding events ( 36 , 37 ). Thus, we believe that the intensive thromboprophylaxis protocol suggested by Stessel et al seems promising as a chemoprophylaxis regimen until further data from ongoing randomized clinical trials (RCTs) become available ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Venous Thromboembolism in Critically Ill COVID-19 Patients: Systematic Review and Meta-Analysis

Mohamed

Al-Shokri

Shunnar

et al. 2021

Front. Cardiovasc. Med.

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Background: Recent studies revealed a high prevalence of venous thromboembolism (VTE) events in coronavirus disease 2019 (COVID-19) patients, especially in those who are critically ill. Available studies report varying prevalence rates. Hence, the exact prevalence remains uncertain. Moreover, there is an ongoing debate regarding the appropriate dosage of thromboprophylaxis.Methods: We performed a systematic review and proportion meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed and EMBASE for studies exploring the prevalence of VTE in critically ill COVID-19 patients till 25/07/2020. We pooled the proportion of VTE. Additionally, in a subgroup analysis, we pooled VTE events detected by systematic screening. Finally, in an exploratory analysis, we compared the odds of VTE in patients on prophylactic compared with therapeutic anticoagulation.Results: The review comprised 24 studies and over 2,500 patients. The pooled proportion of VTE prevalence was 0.31 [95% confidence interval (CI) 0.24, 0.39; I2 94%], of VTE utilizing systematic screening was 0.48 (95% CI 0.33, 0.63; I2 91%), of deep venous thrombosis was 0.23 (95% CI 0.14, 0.32; I2 96%), and of pulmonary embolism was 0.14 (95% CI 0.09, 0.20; I2 90%). Exploratory analysis of few studies, utilizing systematic screening, VTE risk increased significantly with prophylactic, compared with therapeutic anticoagulation [odds ratio (OR) 5.45; 95% CI 1.90, 15.57; I2 0%].Discussion: Our review revealed a high prevalence of VTE in critically ill COVID-19 patients. Almost 50% of patients had VTE detected by systematic screening. Higher thromboprophylaxis dosages may reduce VTE burden in this patient's cohort compared with standard prophylactic anticoagulation; however, this is to be ascertained by ongoing randomized controlled trials.

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Bleeding prevalence in COVID-19 patients receiving intensive antithrombotic prophylaxis

Cited by 15 publications

References 14 publications

Management of therapeutic unfractionated heparin in COVID‐19 patients: A retrospective cohort study

Management of therapeutic unfractionated heparin in COVID‐19 patients: A retrospective cohort study

Prevalence of Venous Thromboembolism in Critically-ill COVID-19 Patients: Systematic Review and Meta-analysis

Prevalence of Venous Thromboembolism in Critically Ill COVID-19 Patients: Systematic Review and Meta-Analysis

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