Gastrointestinal Bleeding in Hospitalized covid‐19 Patients: a propensity Score Matched Cohort Study

Accepted Article

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hospitalization. Proton pump inhibitors and histamine receptor blockers were also not associated with 

a protective effect against the development GI bleed. 

Outcomes

Outcomes of mortality and need for mechanical ventilation were examined between GI bleeding 

groups and non-GI bleeding groups for patients admitted with a GI bleed and those who developed a 

GI bleed during the hospitalization. There was no difference in mortality (OR 0.62, 95%CI  0.31-1.24, 

p=0.17) or need for mechanical ventilation (OR 0.50, 95%CI  0.21-1.17, p=0.10) in patients admitted 

with a GI bleed. However, an association was observed for patients who developed a GI bleed during 

the hospitalization in which an increased mortality was observed (OR 1.58, 95% CI 1.06-2.34, 

p=0.02). There was no statistical difference in the need for mechanical ventilation (OR 1.34, 95%CI 

0.88-2.04, p=0.17).

DISCUSSION

Providing anticoagulation therapy for COVID-19 related coagulopathy or for a markedly elevated 

serum D-dimer has become standard of care in many hospitals due to observational analyses showing 

a mortality benefit[12,18]  Randomized controlled trials are underway in order to provide prospective 

data to inform this therapeutic approach (NCT04406389, NCT04359277, NCT04367831, 

NCT04512079, NCT04401293, NCT04409834).  

Despite the push to treat severe COVID-19 patients with anticoagulation therapy, the risks are not 

well understood.  Given observational studies showing severe GI bleeding in COVID-19 patients, it is 

unclear if this is a consequence of this therapy. Our current study aimed to answer this question. 

In this analysis of over 11,000 patients in New York, which once served as the epicenter of the 

COVID-19 pandemic, we found a 3% rate of gastrointestinal bleeding with 104 who presented with 

GI bleeding on admission and 210 who developed GI bleeding during hospitalization. Interestingly, 

medications traditionally known to be associated with increased risk of GI bleeding including