Observed risk of recurrent bleeding and thromboembolic disease in COVID-19 patients with gastrointestinal bleeding

Emmanuel Attah; Tracey A Martin; Emily S Smith; Sunena Tewani; Kaveh Hajifathalian; Reem Z Sharaiha; Carl V Crawford; David Wan

doi:10.1055/a-1497-1801

Observed risk of recurrent bleeding and thromboembolic disease in COVID-19 patients with gastrointestinal bleeding

Endosc Int Open. 2021 Aug 23;9(9):E1435-E1444. doi: 10.1055/a-1497-1801. eCollection 2021 Sep.

Authors

Emmanuel Attah¹, Tracey A Martin², Emily S Smith¹, Sunena Tewani³, Kaveh Hajifathalian², Reem Z Sharaiha², Carl V Crawford², David Wan²

Affiliations

¹ Medicine, Weill Cornell Internal Medical College, New York Presbyterian Hospital, New York, New York, United States.
² Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, United States.
³ Division of Hospital Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, United States.

Abstract

Background and study aim COVID-19 patients are at increased risk for venous thromboembolism (VTE) requiring the use of anticoagulation. Gastrointestinal bleeding (GIB) is increasingly being reported, complicating the decision to initiate or resume anticoagulation as providers balance the risk of thrombotic disease with the risk of bleeding. Our study aimed to assess rebleeding rates in COVID-19 patients with GIB and determine whether endoscopy reduces these rebleeding events. We also report 30-day VTE and mortality rates. Methods This was a retrospective study evaluating 56 COVID-19 patients with GIB for the following outcomes: 30-day rebleeding rate, 30-day VTE rate, effects of endoscopic intervention on the rate of rebleeding, and 30-day mortality. Results The overall rates of VTE and rebleeding events were 27 % and 41 %, respectively. Rebleeding rates in patients managed conservatively was 42 % compared with 40 % in the endoscopy group. Overall, 87 % of those who underwent invasive intervention resumed anticoagulation vs. 55 % of those managed medically ( P = 0.02). The all-cause 30-day mortality and GIB-related deaths were 32 % and 9 %, respectively. Mortality rates between the endoscopic and conservative management groups were not statistically different (25 % vs. 39 %; P = 0.30). Conclusions Although rebleeding rates were similar between the endoscopic and conservative management groups, patients who underwent intervention were more likely to restart anticoagulation. While endoscopy appeared to limit the duration that anticoagulation was withheld, larger studies are needed to further characterize its direct effect on mortality outcomes in these complex patients.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).