Retrospective studies and systematic-review meta-analysis have shown an association in inducing a prothrombotic state in patients infected with COVID-19. The risk of VTE are compounded in the critically ill. Current practices at Baptist Hospital of Miami (BHM) is to routinely order standard prophylactic dosed chemical thromboprophylaxis for all patients infected with COVID-19. In August 2020 an anticoagulation guidance document was approved to tailor anticoagulation dosing for critically ill COVID-19 patients. At risk patients were based on clinical and laboratory markers such as D-dimer, CRP, and ferritin. Following implementation, our analysis show a statistically significant reduction in the number of treatment dose anticoagulation used within the intensive care units and a statistically significant increase in the number of intermediate intensity anticoagulation ordered. The rate of bleeding was similar before and after implementation, and the rate of venous thromboembolism no statistical difference with a relative risk (RR) of 1.88 (95% CI 0.78 to 4.50). However given the high frequency of VTE further evaluation is underway. Additionally, pending peer review, the REMAP-CAP, ATTACC, and ACTIV-4A is expected to guide clinical practice in the prevention of COVID-19 associated VTE.
Virtual Florida Residency Conference
Tony Nguyen - Pharmacy Resident PGY2
Nguyen, Tony and Clarke, Heidi, "Evaluation of an elevated VTE thromboprophylaxis guideline for critically ill patients infected with COVID-19" (2021). All Publications. 4016.
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