Thrombotic Events and Anticoagulation-Related Bleeding Complications in Critically Ill Patients with Coronavirus Disease 2019

Mayur Narayan, Nicole Leahy, Dalia Alqunaibit, Anjile An, Paolo De Angelis, Matthew Bronstein, Soumitra Eachempati, Cameron Gibson, Anton Kelly, Jennifer A. Minneman, Jian Shou, Kira E. Smith, Cassandra Villegas, Robert J. Winchell, Corey Witenko, Philip S. Barie

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Thrombosis (T) is common in coronavirus disease 2019 (COVID-19) patients, and d-dimer concentrations correlate with outcomes. Controversy exists with regards to anticoagulation (AC) for patients. We implemented a full-heparinization AC protocol from the onset of the pandemic and hypothesized that a safety signal would be undetectable. Patients and Methods: Prospective evaluation of 111 patients with COVID-19 critical illness hospitalized from March to June 2020. All patients received therapeutic heparinoid-based AC from admission. Incidences of T, bleeding (B), or both (BT) were noted. The primary outcome was mortality. Kruskal-Wallis test and logistic regression were performed. Results are expressed as n (%), median (interquartile range) and odds ratios with 95% confidence intervals. Alpha was set at 0.05. Results: Thirty-two patients (28%) had T, 23 (20%) had B, and 14 (12%) had BT; 42 (40%) patients were unaffected. Two logistic regression models (outcome = mortality) evaluated BT as T, or BT as B. For BT as T, neither T, B, nor male gender predicted mortality; similarly, for BT as B, neither T, B, nor male gender predicted mortality. Factors associated with higher odds of death included higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.00-1.13; p = 0.0045), higher d-dimer concentration (OR, 1.00; 95% CI, 1.00-1.01; p = 0.043), and higher activated partial thromboplastin time (aPTT; OR, 1.09; 95% CI, 1.02-1.16; p = 0.010). Conclusions: Neither T nor B predicted mortality in this prospective cohort of anticoagulated patients with COVID-19 critical illness. These data support continued full-dose heparinoid prophylaxis.

Original languageEnglish (US)
Pages (from-to)705-711
Number of pages7
JournalSurgical Infections
Issue number8
StatePublished - Oct 1 2022
Externally publishedYes


  • COVID-19
  • anticoagulation
  • bleeding
  • coagulopathy
  • therapeutic complication
  • thrombosis

ASJC Scopus subject areas

  • Surgery
  • Microbiology (medical)
  • Infectious Diseases


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