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

Accepted Article

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patients hospitalized with COVID-19 may be at risk of gastrointestinal (GI) bleeding[4–8].  However 

the prevalence, etiology, risk factors, and outcomes for the patients who develop this complication 

have not been well studied. Understanding these factors has important implications in the 

understanding and management of COVID-19, particularly as clinical observations reveal increased 

rates of thrombosis, suggestive of a COVID-19 related coagulopathy. [6,9–13]. Autopsy studies have 

shown increased rates of micro and macro thrombi, not otherwise suspected pre-mortem.[13–16].  As 

a result, in severe COVID-19, many patients have been started on prophylactic dosing anticoagulation 

with observational analyses suggesting a mortality benefit[12,17–19] Still the initiation of 

anticoagulation is not without risk, particularly as to whether it will contribute to increased GI 

bleeding. A recent retrospective study showed that COVID-19 patients treated with antithrombotic 

drugs are at increased risk of bleeding [8]. Other possible mechanisms for GI bleeding include stress 

ulcer formation from hospitalization[7,20] hemorrhagic colitis possibly secondary to SARS-CoV-

2[21], or disseminated intravascular coagulation induced bleeding[6].  

The aims of our study were 1) To examine if there are risk factors for GI bleeding in patients with 

COVID-19, with a focus on anticoagulation and antiplatelet medications known to predispose to 

bleeding 2) to study whether there is a mortality difference between hospitalized patients with 

COVID-19 with and without GI bleeding.   

METHODS

This is a nested propensity score matched case-control study of 11,158 adult patients (18+ years old) 

admitted to Northwell Health System between March 1

st

 and April 27

th 

and diagnosed with COVID-

19. Hospitals from Manhattan, Long Island, Queens, and Staten Island were included in this analysis. 

Institutional Review Board approval was obtained for this study.  Patients were considered positive 

for COVID-19 if they tested positive for SARS-CoV-2 infection by polymerase chain reaction from 

nasal swabs.