Mallory Fiorenza, BCPS, PharmD, BCCCP
Lee Memorial Hospital
Fort Myers, Florida
Disclosure information not submitted.
Jordan Taillon, M.D.
Pulmonologist and Critical Care Specialist
Lee Health, United States
Disclosure information not submitted.
Sunil Pammi, MD
Critical Care Pulmonologist
Lee Health, United States
Disclosure information not submitted.
Title: Assessment of an anticoagulation protocol for COVID-19 patients within a community health-system
Introduction:
In addition to the respiratory effects of the coronavirus disease 2019 (COVID-19), inflammation, endothelial damage, and immobility predisposes patients to thrombotic complications. Patients in the intensive care unit (ICU) have a reported 10% risk of venous thromboembolism (VTE) observed with prophylactic anticoagulation (AC). Comparatively, patients with COVID-19 infection have an elevated risk of VTE (42-69%) and may require higher doses of prophylactic AC. The purpose of this evaluation was to assess the use of an AC protocol for COVID-19 within a community health-system.
Methods:
This was a retrospective chart review of adult hospitalized patients with confirmed COVID-19 at a 1400-bed community health-system admitted between May 2020 and August 2020. The primary outcome was to assess if intermediate (ID) or full dose (FD) AC was prescribed to patients diagnosed with COVID-19 with an initial d-dimer of ≥ 2.5 μg/mL as recommended per health-system’s protocol. Secondary outcomes included the incidence of in-hospital VTE, risk of adverse bleeding complications, ICU and hospital length of stay (LOS), in-hospital mortality and incidence of patients discharged home on AC.
Results:
A total of 189 patients were included in the analysis. For the primary outcome, 17% (32/189) of patients met criteria for ID or FD AC per the health-system’s protocol. The overall incidence of thrombotic events was 8.5% (16/189) regardless of the initial AC regimen. Hemorrhagic events only occurred in 5.3% (10/189) of patients and 20% of these patients died (2/10). The median hospital and ICU LOS was 7 days with 48 patients (25%) requiring an ICU admission. Fifty-two (27.5%) patients were discharged home on AC as recommended by health-system’s protocol. In-hospital mortality was 20% (37/189).
Conclusion:
This evaluation demonstrated only 17% of patients met criteria for ID or FD AC per the health-system’s protocol. The incidence of VTE (8.5%) in this evaluation was considerably lower than previously reported in the literature (42-69%). However, the incidence of bleeding events (5.3%) was higher in this evaluation than previously reported. Further studies are warranted to determine if the use of intermediate or full dose AC should be utilized in patients with COVID-19 with an elevated d-dimer greater than or equal to 2.5 μg/mL.