A0289 - Resource Utilization for Gastrointestinal Bleeding in Critically Ill Patients with COVID-19 Pneumonia

Introduction: During the coronavirus disease 2019 (COVID-19) epidemic, thrombosis contributed to morbidity and mortality. Managing thrombosis in critically ill patients became challenging – as routine evaluation methods were unavailable. Studies have shown no mortality benefit for therapeutic anticoagulation with heparin for those critically ill with COVID-19. Our study expands beyond heparin to other methods of anticoagulation and investigates the impact of therapeutic anticoagulation on mortality, length of stay, ICU days, blood transfusions, gastroenterology consultations, and endoscopic procedures.

Methods: This is a retrospective chart review of 15,707 patients admitted to hospitals in HCA Healthcare’s West Florida Division. Charts from January 2019 – October 2021 were used to identify adult patients admitted to the intensive care unit for COVID-19 pneumonia. Patients with confirmed pulmonary emboli, deep venous thrombosis, or other conditions requiring anticoagulation were excluded. Those who met the inclusion criteria were divided by whether they had received thromboprophylaxis or therapeutic anticoagulation. The analyzed outcomes were mortality, length of stay, ICU days, gastroenterology consultation, endoscopic procedures, and blood transfusions.

Results: Therapeutically anticoagulated patients with Covid-19 were more likely to receive blood transfusions or a gastroenterology consultation than the same group of patients receiving thromboprophylaxis. Length of stay (LOS) and days in the intensive care unit were significantly longer by 31% and 34% (p < 0.0001), respectively, for therapeutically anticoagulated patients. Of note, there was an increased in endoscopic procedures for patients on therapeutic anticoagulation; however, the difference was not statistically significant. Our study showed therapeutically anticoagulated patients were twice as likely to die during admission as those who only received thromboprophylaxis.

Discussion: Our study shows a statistically significant increase in mortality, LOS, ICU days, transfusions, and gastroenterology consultations for patients on therapeutic anticoagulation. There was an increase in endoscopic procedures; however it was not statistically significant. This may be in part due to the small number of patients who received endoscopic procedures (less than 1.5% of our study sample). Our results speak to the dangers of empiric anticoagulation in the study population and caution against treating laboratory values for future novel diseases.