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Risk factors for thromboembolism and bleeding in COVID-19: lessons from Wuhan

Presented By
Prof. Yutao Guo , Chinese PLA General Hospital, China
ESC 2020

An evaluation of patients with COVID-19 who were admitted to the hospital in Wuhan, China, showed that they were at high risk for thromboembolic and bleeding events, as well as mortality [1]. Anticoagulant use, especially use of parenteral anticoagulants, significantly reduced the risk of the composite outcome of thromboembolism, bleeding events, and death. The presence of atrial fibrillation (AF) was a contributor to systemic thromboembolism in COVID-19 patients.

COVID-19 is associated with a high risk of thrombotic complications, which contribute to the high mortality rate. Limited data is yet available on systemic thromboembolism and the value of anticoagulation regimens. Prof. Yutao Guo (Chinese PLA General Hospital, China) presented the study that investigated the prevalence of systemic and venous thromboembolism, as well as major bleeding and mortality, in relation to underlying risk factors and the impact of anticoagulation use in hospitalised patients with COVID-19.

The study enrolled 1,125 patients with COVID-19 admitted to Union Hospital, Wuhan, China. Half of the participants (49.9%) were male and mean age was 58 years (36.3% were >65 years). They were followed for a mean of 21 days. Of the participants, 33 (2.9%) underwent surgery, and 249 patients (22.1%) received anticoagulants, of whom 7.7% received oral anticoagulants, 18.6% parenteral anticoagulants, and 4.2% oral plus parenteral anticoagulants.

Thromboembolic and bleeding events

There were 82 thromboembolism events (7.3%; 37 systemic and 45 venous events), 128 major bleeding events (11.4%), and 91 deaths (8.1%). About 25 patients (30%) with thromboembolism also suffered bleeding events. Age was an independent risk factor for thromboembolism, bleeding events, and death (all P<0.05).

After adjusting for the severity of COVID-19 infection, comorbidities, surgery, and use of antiviral drugs, immunomodulators, Chinese herbs, and antithrombotic drugs:

  • low lymphocyte counts (HR 1.03; P=0.01) and surgery (HR 2.80; P=0.03) independently predicted the risk for major bleeding;
  • liver dysfunction (HR 4.13; P=0.02) was an independent risk factor for patients with both thromboembolism and bleeding events; and
  • AF or irregular rhythm increased the risk for systemic thromboembolism (HR 3.16; P=0.04).

Anticoagulant use

Both oral anticoagulant (HR 0.32) and parenteral anticoagulant (HR 0.39) use reduced the risk for thromboembolism (all P<0.001). After adjustment, parenteral anticoagulant use had a borderline significant effect on both thromboembolism and bleeding events (HR 0.36; P=0.053), but significantly reduced the risk for the composite outcome of thromboembolism, bleeding events, and mortality (HR 0.70; P=0.02).


    1. Guo Y. Risk factors for systemic and venous thromboembolism, mortality and bleeding risk in 1125 patients with COVID-19: relationship to anticoagulation status. COVID and Cardiovascular Disease session, ESC Congress 2020, 30 Aug.


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