08 February 2022

Patients in intensive care with COVID-19 may face a significantly increased risk of heavy bleeding when given full doses of anticoagulants, according to a new analysis.

A study led by researchers at the University of Buffalo, New York, USA, compared the safety and effectiveness of blood clot treatment strategies for more than 150 critically ill COVID-19 patients at two hospitals.

They found that almost all patients who experienced significant bleeding were mechanically ventilated and receiving full-dose anticoagulants.

The findings, published in Hospital Pharmacy, could inform treatment guidelines for blood clots in hospitalised COVID-19 patients, who are at an increased risk for both blood clots and severe bleeding.

First author Dr Maya Chilbert, clinical assistant professor in the UB School of Pharmacy and Pharmaceutical Sciences, said previous reports have found that 17% of hospitalised COVID-19 patients experience blood clots.

The study analysed the outcome of blood clot treatments and the rate of bleeding events for more than 150 patients with COVID-19 who received either of two blood thinner regimens: a full-dose based on patient levels of D-dimer and the other a smaller but higher-than-standard dosage.

The average patient age was 58, and all experienced elevated levels of D-dimer, fibrinogen and prothrombin time.

Nearly 14% of patients who received full-dose blood thinners experienced a significant bleeding event, compared to 3% of patients who received a higher-than-standard dosage.

All patients who experienced bleeding events were mechanically ventilated. No difference was reported in either regimens’ effectiveness at treating blood clots.

“A wide variety of practice exists when it comes to approaching blood clots in hospitalised patients with COVID-19, and there is little data to suggest improved outcomes using one strategy versus another,” said Dr Maya Chilbert.

“Caution should be used in mechanically ventilated patients with COVID-19 when selecting a regimen to treat blood clots, and the decision to use full-dose blood thinners should be based on a compelling indication rather than lab markers alone.”

Dr Chilbert said further studies are needed to determine the optimal strategy for treating blood clots and bleeding in hospitalised COVID-19 patients.


Chilbert MR, Clark CM, Woodruff AE, Zammit K, Lackie C, Kusmierski K, McGrath P, Fuhrer G, Augostini A, Denny O, Ross N, Saber M, DelGuidice N. (2021) “Comparison of Higher-Than-Standard to D-Dimer Driven Thromboprophylaxis in Hospitalized Patients With COVID-19.” Hospital Pharmacy, doi: 10.1177/00185787211066456

Link: https://journals.sagepub.com/doi/10.1177/00185787211066456

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