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Al Raizah A, Al Askar A, Shaheen N, et al. High rate of bleeding and arterial thrombosis in COVID-19: Saudi multicenter study. Thromb J. 2021;19(1):13doi: 10.1186/s12959-021-00265-y.
Al Raizah, A., Al Askar, A., Shaheen, N., Aldosari, K., Alnahdi, M., Luhanga, M., Alshuaibi, T., Bajhmoum, W., Alharbi, K., Alsahari, G., Algahtani, H., Alrayes, E., Basendwah, A., Abotaleb, A., & Almegren, M. (2021). High rate of bleeding and arterial thrombosis in COVID-19: Saudi multicenter study. Thrombosis journal, 19(1), 13. https://doi.org/10.1186/s12959-021-00265-y
Al Raizah, Abdulrahman, et al. "High rate of bleeding and arterial thrombosis in COVID-19: Saudi multicenter study." Thrombosis journal vol. 19,1 (2021): 13. doi: https://doi.org/10.1186/s12959-021-00265-y
Al Raizah A, Al Askar A, Shaheen N, Aldosari K, Alnahdi M, Luhanga M, Alshuaibi T, Bajhmoum W, Alharbi K, Alsahari G, Algahtani H, Alrayes E, Basendwah A, Abotaleb A, Almegren M. High rate of bleeding and arterial thrombosis in COVID-19: Saudi multicenter study. Thromb J. 2021 Mar 03;19(1):13. doi: 10.1186/s12959-021-00265-y. PMID: 33658062; PMCID: PMC7928187.
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Thromb J. 2021 Mar 03;19(1):13. doi: 10.1186/s12959-021-00265-y.

High rate of bleeding and arterial thrombosis in COVID-19: Saudi multicenter study.

Thrombosis journal

Abdulrahman Al Raizah, Ahmed Al Askar, Naila Shaheen, Khalid Aldosari, Mohamed Alnahdi, Musumadi Luhanga, Turki Alshuaibi, Wail Bajhmoum, Khaled Alharbi, Ghaida Alsahari, Hadeel Algahtani, Eunice Alrayes, Abdulrahim Basendwah, Alia Abotaleb, Mosaad Almegren

Affiliations

  1. Division of Adult Hematology, Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, PO Box. 22490, 11426, Riyadh, Saudi Arabia. [email protected].
  2. King Abdullah International Medical Research Center, Saudi Society for Bone Marrow Transplant, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. [email protected].
  3. King Saud bin Abdulaziz University of Health Sciences, Riyadh, Saudi Arabia. [email protected].
  4. Division of Adult Hematology, Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, PO Box. 22490, 11426, Riyadh, Saudi Arabia.
  5. King Abdullah International Medical Research Center, Saudi Society for Bone Marrow Transplant, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
  6. King Saud bin Abdulaziz University of Health Sciences, Riyadh, Saudi Arabia.
  7. Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
  8. Department of Medicine, King Fahd Hospital, Jeddah, Saudi Arabia.
  9. Department of Medicine, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia.
  10. Oncology Division, Medicine Department, King Fahad Armed Forces Hospital, Jeddah, Mecca, Saudi Arabia.
  11. Department of Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.

PMID: 33658062 PMCID: PMC7928187 DOI: 10.1186/s12959-021-00265-y

Abstract

BACKGROUND: Several observational studies have reported the rate of venous and arterial thrombotic events in patients infected with COVID-19, with conflicting results. The aim of this study was to estimate the rate of thrombotic and bleeding events in hospitalized patients diagnosed with Coronavirus disease 2019 (COVID-19).

METHODS: This was a multicenter study of 636 patients admitted between 20 March 2020 and 31 May 2020 with confirmed COVID-19 in four hospitals.

RESULTS: Over a median length of stay in the non-ICU group of 7 days and of 19 days in the ICU group, twelve patients were diagnosed with Venous thromboembolism (VTE) (1.8 %) (95 % CI, 1.1-3). The rate in the non-ICU group was 0.19 % (95 % CI, 0.04-0.84), and that in the ICU group was 10.3 % (95 % CI, 6.4-16.2). The overall rate of arterial event is 2.2 % (95 % CI, 1.4-3.3). The rates in the non-ICU and ICU groups were 0.94 % (95 % CI, 0.46-0.1.9) and 8.4 % (95 % CI, 5.0-14.0). The overall composite event rate was 2.9 % (95 % CI, 2.0-4.3). The composite event rates in the non-ICU and ICU groups were 0.94 % (95 % CI, 0.46-0.1.9) and 13.2 % (95 % CI, 8.7-19.5). The overall rate of bleeding is 1.7 % (95 % CI, 1.0-2.8). The bleeding rate in the non-ICU group was 0.19 % (95 % CI, 0.04-0.84), and that in the ICU group was 9.4 % (95 % CI, 5.7-15.1). The baseline D-dimer level was a significant risk factor for developing VTE (OR 1.31, 95 % CI, 1.08-1.57, p = 0.005) and composite events (OR 1.32, 95 % CI, 1.12-1.55, p = 0.0007).

CONCLUSIONS: In this study, we found that the VTE rates in hospitalized patients with COVID-19 might not be higher than expected. In contrast to the risk of VTE, we found a high rate of arterial and bleeding complications in patients admitted to the ICU. An elevated D-dimer level at baseline could predict thrombotic complications in COVID-19 patients and may assist in the identification of these patients. Given the high rate of bleeding, the current study suggests that the intensification of anticoagulation therapy in COVID-19 patients beyond the standard of care be pursued with caution and would best be evaluated in a randomized controlled study.

Keywords: Arterial thrombosis; Bleeding; COVID-19; Coronavirus; SARS-CoV-2; Saudi; Stroke; Thrombosis; Venous thromboembolism

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