Tariq Kewan MD, n/a
Physician
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Disclosure information not submitted.
Abhishek Bhardwaj, MD, FACP
Cleveland Clinic Foundation
Cleveland, Ohio
Disclosure information not submitted.
Mahmoud Alwakeel MD, n/a
Resident
Cleveland Clinic- Fairview, United States
Disclosure information not submitted.
Monica Flores MD, n/a
Resident
Cleveland Clinic Fairview
Cleveland, Ohio, United States
Disclosure information not submitted.
Gretchen Sacha, BCCCP, PharmD
Critical Care Clinical Specialist
Cleveland Clinic
Cleveland, Ohio
Disclosure information not submitted.
Douglas Joseph DO, n/a
Physician
Cleveland Clinic Foundation, United States
Disclosure information not submitted.
Keith McCrae MD, n/a
Physician
Cleveland Clinic Foundation, United States
Disclosure information not submitted.
Michael Militello PharmD, n/a
Pharmacist
Cleveland Clinic Foundation, United States
Disclosure information not submitted.
Xiaofeng Wang, PhD
Biostatistician
Cleveland Clinic Foundation, United States
Disclosure information not submitted.
Manik Aggarwal MD, n/a
Resident
Cleveland Clinic Foundation, United States
Disclosure information not submitted.
Mohammed Al-Jaghbeer MD
Physician
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Disclosure information not submitted.
Bassel Akbik MD, n/a
Physician
Cleveland Clinic Foundation, United States
Disclosure information not submitted.
Abhijit Duggal, MD, MPH, MSc, FACP
Assistant Professor
Cleveland Clinic Foundation, United States
Disclosure information not submitted.
Simon Mucha, MD, FACP
Physician
Cleveland Clinic Foundation, United States
Disclosure information not submitted.
Title: Impact of D-dimer & weight-based thrombosis prophylaxis protocol in critically ill COVID-19 patients
Introduction: COVID-19 disease is associated with an increased risk of thrombosis. The optimal prophylaxis strategy for patients in ICU remains unclear. We evaluated the impact of a weight and D-dimer guided high intensity prophylaxis protocol implemented in the intensive care units (ICUs) across the Cleveland Clinic Health System (CCHS).
Methods: Multicenter, retrospective, before-after study, evaluating the incidence of thrombotic and bleeding events in patients with COVID-19 admitted to ICUs across the CCHS between 02/2020 and 09/2020. A high-intensity thrombosis prophylaxis protocol based on D-dimer and weight was implemented across the healthcare system on 04/2020. Patients were divided into two cohorts, before and after protocol implementation. Univariable and multivariable logistic regression analysis were used to model the thrombosis and bleeding events.
Results: 788 patients were included in the study; 74% (583) were admitted after the protocol activation. 94 patients (11.9%) developed 101 thrombotic events. After protocol implementation we observed a lower rate of overall thrombotic events (15.1% vs 10.8% p-0.09), DVTs (10.4% vs 9.0% p=0.56) and PEs (5.7 vs 1.0% p-0.00). Compliance with the prophylaxis protocol was 90%. Patients admitted after protocol implementation had higher rates of high-intensity prophylaxis (34.7% vs. 22.6%) and therapeutic anticoagulation (22.7% vs. 15.1%). Adjusted multivariable regression analysis showed a significant lower risk of developing thrombosis for patients admitted after protocol implementation (OR= 0.57, 95% CI: 0.34 – 0.95). Overall bleeding (3.6% vs. 18.4%, p=0.073) and major bleeding rates (2.6% vs. 10.9%, p=0.076) were lower after implementation. Neither the use of therapeutic anticoagulation (OR: 1.01, 95% CI: 0.29 – 3.44) nor high intensity prophylaxis (OR: 1.25, 95% CI: 0.51 – 3.07) were associated with a significant increase in bleeding risk.
Conclusions: This large, retrospective multicenter before-after study showed reduced incidence rates of thrombosis without excess bleeding after the system wide implementation of a high intensity, individualized, weight and D-dimer based VTE prophylaxis protocol. These data suggest this protocol is a safe and effective thrombosis prophylaxis strategy for critically ill ICU patients with COVID-19.