Empiric Anticoagulation Therapy in Hospitalized COVID-19 Patients: An Evaluation of Bleeding Risk Scores Performances in Predicting Bleeding Events
Currently, there is no standardized consensus on anticoagulation (AC) among patients with coronavirus disease (COVID-19), which has an overwhelming bleeding risk. We aimed to compare the patterns of AC in COVID-19 patients and compare two validated risk scores in predicting bleeding events. A retros...
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| Format: | Article |
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MDPI AG
2022-08-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/17/4965 |
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| author | Mona A. Abdelrahman Aya Ahmed Abdullah S. Alanazi Hasnaa Osama |
| author_facet | Mona A. Abdelrahman Aya Ahmed Abdullah S. Alanazi Hasnaa Osama |
| author_sort | Mona A. Abdelrahman |
| collection | DOAJ |
| description | Currently, there is no standardized consensus on anticoagulation (AC) among patients with coronavirus disease (COVID-19), which has an overwhelming bleeding risk. We aimed to compare the patterns of AC in COVID-19 patients and compare two validated risk scores in predicting bleeding events. A retrospective review of medical records was conducted for COVID-19 patients who received empiric anticoagulation therapy. The primary outcomes included bleeding events, survival, and mechanical ventilation needs. We applied the HAS-BLED and ORBIT bleeding risk scores to assess the predictive accuracy, using c-statistics and the receiver operating curve (ROC) method. Of the included patients (<i>n</i> = 921), with a mean age of 58.1 ± 13.2, 51.6% received therapeutic AC and 48.4% received a prophylactic AC dose. Significantly higher values of <span style="font-variant: small-caps;">d</span>-dimer and C-reactive protein (CRP) among the therapeutic AC users (<i>p</i> < 0.001) were noted with a significantly prolonged duration of hospital stay and mechanical ventilation (<i>p</i> < 0.001 and <i>p</i> = 0.011, respectively). The mean value of the HAS-BLED and ORBIT scores were 2.53 ± 0.93 and 2.26 ± 1.29, respectively. The difference between the two tested scores for major bleeding and clinically relevant non-major bleeding was significant (<i>p</i> = 0.026 and 0.036, respectively) with modest bleeding predictive performances. The therapeutic AC was associated with an increased risk of bleeding. HAS-BLED showed greater accuracy than ORBIT in bleeding risk predictability. |
| first_indexed | 2024-03-10T01:40:50Z |
| format | Article |
| id | doaj.art-e585caadfb104146b987af737e4e8225 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T01:40:50Z |
| publishDate | 2022-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-e585caadfb104146b987af737e4e82252023-11-23T13:25:15ZengMDPI AGJournal of Clinical Medicine2077-03832022-08-011117496510.3390/jcm11174965Empiric Anticoagulation Therapy in Hospitalized COVID-19 Patients: An Evaluation of Bleeding Risk Scores Performances in Predicting Bleeding EventsMona A. Abdelrahman0Aya Ahmed1Abdullah S. Alanazi2Hasnaa Osama3Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni Suef 2722165, EgyptDepartment of Clinical Pathology, Faculty of Medicine, Beni-Suef University, Beni Suef 2722165, EgyptDepartment of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi ArabiaDepartment of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni Suef 2722165, EgyptCurrently, there is no standardized consensus on anticoagulation (AC) among patients with coronavirus disease (COVID-19), which has an overwhelming bleeding risk. We aimed to compare the patterns of AC in COVID-19 patients and compare two validated risk scores in predicting bleeding events. A retrospective review of medical records was conducted for COVID-19 patients who received empiric anticoagulation therapy. The primary outcomes included bleeding events, survival, and mechanical ventilation needs. We applied the HAS-BLED and ORBIT bleeding risk scores to assess the predictive accuracy, using c-statistics and the receiver operating curve (ROC) method. Of the included patients (<i>n</i> = 921), with a mean age of 58.1 ± 13.2, 51.6% received therapeutic AC and 48.4% received a prophylactic AC dose. Significantly higher values of <span style="font-variant: small-caps;">d</span>-dimer and C-reactive protein (CRP) among the therapeutic AC users (<i>p</i> < 0.001) were noted with a significantly prolonged duration of hospital stay and mechanical ventilation (<i>p</i> < 0.001 and <i>p</i> = 0.011, respectively). The mean value of the HAS-BLED and ORBIT scores were 2.53 ± 0.93 and 2.26 ± 1.29, respectively. The difference between the two tested scores for major bleeding and clinically relevant non-major bleeding was significant (<i>p</i> = 0.026 and 0.036, respectively) with modest bleeding predictive performances. The therapeutic AC was associated with an increased risk of bleeding. HAS-BLED showed greater accuracy than ORBIT in bleeding risk predictability.https://www.mdpi.com/2077-0383/11/17/4965COVID-19anticoagulationbleeding scoreHAS-BLED scoreORBIT score |
| spellingShingle | Mona A. Abdelrahman Aya Ahmed Abdullah S. Alanazi Hasnaa Osama Empiric Anticoagulation Therapy in Hospitalized COVID-19 Patients: An Evaluation of Bleeding Risk Scores Performances in Predicting Bleeding Events Journal of Clinical Medicine COVID-19 anticoagulation bleeding score HAS-BLED score ORBIT score |
| title | Empiric Anticoagulation Therapy in Hospitalized COVID-19 Patients: An Evaluation of Bleeding Risk Scores Performances in Predicting Bleeding Events |
| title_full | Empiric Anticoagulation Therapy in Hospitalized COVID-19 Patients: An Evaluation of Bleeding Risk Scores Performances in Predicting Bleeding Events |
| title_fullStr | Empiric Anticoagulation Therapy in Hospitalized COVID-19 Patients: An Evaluation of Bleeding Risk Scores Performances in Predicting Bleeding Events |
| title_full_unstemmed | Empiric Anticoagulation Therapy in Hospitalized COVID-19 Patients: An Evaluation of Bleeding Risk Scores Performances in Predicting Bleeding Events |
| title_short | Empiric Anticoagulation Therapy in Hospitalized COVID-19 Patients: An Evaluation of Bleeding Risk Scores Performances in Predicting Bleeding Events |
| title_sort | empiric anticoagulation therapy in hospitalized covid 19 patients an evaluation of bleeding risk scores performances in predicting bleeding events |
| topic | COVID-19 anticoagulation bleeding score HAS-BLED score ORBIT score |
| url | https://www.mdpi.com/2077-0383/11/17/4965 |
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