Bleeding complications in critically ill COVID‐19 patients receiving anticoagulation in a tertiary hospital intensive care unit

Abstract

Background. Coronavirus disease‐2019 (COVID‐19) is associated with a heightened inflammatory response, leading to thromboembolic events that influence patient outcomes. Complex anticoagulation strategies are often required to mitigate these complications. However, severe illness combined with such strategies may be associated with bleeding at multiple sites. Objectives. To describe the incidence of bleeding and venous thromboembolism (VTE) in critically ill COVID‐19 patients receiving anticoagulation. Secondary objectives were to determine the incidence of transfusion in bleeding patients, and the association between inflammatory markers, coagulation parameters, and bleeding and/or VTE. Length of intensive care unit (ICU) stay and patient outcomes in the same cohort were also investigated. Methods. Participants included adult patients with confirmed COVID‐19 by positive polymerase chain reaction (PCR), admitted to the ICU from 1 April 2020 to 30 April 2021. A p‐value of <0.05 was considered statistically significant. Results. The study population comprised 103 patients. The anticoagulant of choice was low‐molecular‐weight heparin at therapeutic doses (median 80 mg/day). Bleeding occurred in 39.8% (n=41) of patients, predominantly from the oral mucosa (20.4%; n=21) and the gastrointestinal tract (13.6%; n=14). Of the patients who bled, 46.3% (n=19) received blood transfusions. Two patients (1.9%) developed grade 1 deep vein thrombosis. The median length of ICU stay was 7 days. Survival dropped below 50% (n=51) after 10 days of admission, and 25% (n=25) of patients survived beyond 28 days. Overall mortality was high at 65.0% (n=67). Conclusion. COVID‐19‐positive critically ill patients receiving therapeutic anticoagulation exhibited an increased incidence of bleeding, accompanied by a high mortality rate.