COVID-19 coagulopathy and thrombosis: Analysis of hospital protocols in response to the rapidly evolving pandemic

Parks, Anna L.; Auerbach, Andrew D.; Schnipper, Jeffrey L.; Anstey, James; Sterken, David G.; Hecht, Todd E.H.; Fang, Margaret C.; Vaughn, Valerie M; Dunn, Andrew; Linker, Anne S.; Hunt, Daniel; Choi, Justin; Brotman, Daniel J.; Streiff, Michael B.; Mattison, Melissa L. P.; Pappas, Matthew A.; Greysen, S. Ryan; Hemsey, David F.; Dapaah-Afriyie, Kwame; Ahuja, Neera; Collins, William J.; Herzig, Shoshana J.; Bhandari, Sanjay; Schumacher, Eric R.; Duggirala, Vijay; O’Leary, Kevin J.; Ménard, Guy; Lin, Michael

doi:10.1016/j.thromres.2020.09.018

Cited by 15 publications

(21 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[6][7][8][9][10][11] This prompted some clinicians to increase the intensity of anticoagulation used for VTE prophylaxis in patients with COVID-19 from standard to intermediate or even therapeutic intensity. 12,13 Potentially because of increased awareness of the thrombotic risks of COVID-19 or use of increased intensity of anticoagulation, more recent data from institutions in the United States reported a lower incidence of thrombosis. 14,15 Expert guidance on VTE prophylaxis in patients with COVID-19 has varied because of a lack of randomized controlled trials.…”

Section: Introductionmentioning

confidence: 99%

“…Initial reports in patients with COVID‐19 suggested a much higher rate of VTE, ranging from 17% to 69% 6–11 . This prompted some clinicians to increase the intensity of anticoagulation used for VTE prophylaxis in patients with COVID‐19 from standard to intermediate or even therapeutic intensity 12,13 . Potentially because of increased awareness of the thrombotic risks of COVID‐19 or use of increased intensity of anticoagulation, more recent data from institutions in the United States reported a lower incidence of thrombosis 14,15 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Bleeding risk by intensity of anticoagulation in critically ill patients with COVID‐19: A retrospective cohort study

Halaby

Cuker

Yui

et al. 2021

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

Background: Studies report hypercoagulability in coronavirus disease 2019 , leading many institutions to escalate anticoagulation intensity for thrombosis prophylaxis.Objective: To determine the bleeding risk with various intensities of anticoagulation in critically ill patients with COVID-19 compared with other respiratory viral illnesses (ORVI).Patients/Methods: This retrospective cohort study compared the incidence of major bleeding in patients admitted to an intensive care unit (ICU) within a single health system with COVID-19 versus ORVI. In the COVID-19 cohort, we assessed the effect of anticoagulation intensity received on ICU admission on bleeding risk. We performed a secondary analysis with anticoagulation intensity as a time-varying covariate to reflect dose changes after ICU admission.Results: Four hundred and forty-three and 387 patients were included in the COVID-19 and ORVI cohorts, respectively. The hazard ratio of major bleeding for the COVID-19 cohort relative to the ORVI cohort was 1.26 (95% confidence interval [CI]: 0.86-1.86). In COVID-19 patients, an inverse-probability treatment weighted model found therapeutic-intensity anticoagulation on ICU admission had an adjusted hazard ratio of bleeding of 1.55 (95% CI: 0.88-2.73) compared with standard prophylacticintensity anticoagulation. However, when anticoagulation was assessed as a timevarying covariate and adjusted for other risk factors for bleeding, the adjusted hazard ratio for bleeding on therapeutic-intensity anticoagulation compared with standard thromboprophylaxis was 2.59 (95% CI: 1.20-5.57). Conclusions:Critically ill patients with COVID-19 had a similar bleeding risk as ORVI patients. When accounting for changes in anticoagulation that occurred in COVID-19 patients, therapeutic-intensity anticoagulation was associated with a greater risk of major bleeding compared with standard thromboprophylaxis.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bleeding risk by intensity of anticoagulation in critically ill patients with COVID‐19: A retrospective cohort study

Halaby

Cuker

Yui

et al. 2021

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

show abstract

“…As one example, the observation of increased risk of venous thromboembolism in critically ill patients with COVID‐19 patients has particular concern in emergency care, because early anticoagulation may improve outcomes 25–27 . Opinions conflict about the use of empiric full‐dose anticoagulation for patients with known or suspected COVID‐19 28–30 . This debate is at least partly fueled by the lack of data to estimate the risk ratio for the short‐term incidence of venous thromboembolism diagnosis after a positive SARS‐CoV‐2 test, compared with symptomatic patients who test negative for SARS‐CoV‐2 in the emergency care setting 31,32 .…”

Section: Discussionmentioning

confidence: 99%

Multicenter registry of United States emergency department patients tested for SARS‐CoV‐2

et al. 2020

View full text Add to dashboard Cite

This paper summarizes the methodology for the registry of suspected COVID-19 in emergency care (RECOVER), a large clinical registry of patients from 155 United States (US) emergency departments (EDs) in 27 states tested for SARS-CoV-2 from March-September 2020. The initial goals are to derive and test: (1) a pretest probability instrument for prediction of SARS-CoV-2 test results, and from this instrument, a set of simple criteria to exclude COVID-19 (the COVID-19 Rule-Out Criteria-the CORC rule), and (2) a prognostic instrument for those with COVID-19. Patient eligibility included any ED patient tested for SARS-CoV-2 with a nasal or oropharyngeal swab. Abstracted clinical data included 204 variables representing the earliest manifestation of infection, including week of testing, demographics, symptoms, exposure risk, past medical history, test results, admission status, and outcomes 30 days later. In addition to the primary goals, the registry will provide a vital platform for characterizing the course, epidemiology, clinical features, and prognosis of patients tested for COVID-19 in the ED setting.

show abstract

“…Studies from France suggest that PE occurred in COVID-19 patients at a median of 6 days [ 18 ]. As a marker for hemostasis, D-dimer testing has been followed almost the world over; however, necessitating D-dimer in diagnostic decision-making for PE has an overall varied response [ 93 , 94 ]. Normal levels of D-dimer have the ability to rule out PE, especially in the context of low pretest probability, and can annul radiological imaging.…”

Section: Diagnosismentioning

confidence: 99%

SARS-CoV-2 Infection: Modulator of Pulmonary Embolism Paradigm

Akhter

Hamali

Mobarki

et al. 2021

JCM

View full text Add to dashboard Cite

Pulmonary embolism (PE) is a life-threatening complication arising from venous thromboembolism with a difficult diagnosis and treatment and is often associated with increased mortality and morbidity. PE had a significantly low incidence prior to the COVID-19 epidemic. This condition saw a sharp surge during the COVID-19 pandemic, indicating an evident viral influence on PE’s pathophysiology in COVID-19 patients. The hypercoagulable state induced by the viral load seems to be the major contributor, and the classical causative factors seem to play a lesser role. PE in COVID-19 infection has become a mammoth challenge since the diagnosis is quite challenging due to overlapping symptoms, lack of prior-known predisposing risk factors, limited resources, and viral transmittance risk. Numerous factors arising out of the viral load or treatment lead to an increased risk for PE in COVID-19 patients, besides the fact that certain unknown risk factors may also contribute to the incidence of PE in COVID-19 patients. The management of PE in COVID-19 infection mainly comprises thromboprophylaxis and anticoagulant therapy with mechanical ventilation, depending on the risk stratification of the patient, with a post-COVID-19 management that prevents recurrent PE and complications. This review aims to discuss various aspects of COVID-19-infection-associated PE and major differential aspects from non-COVID-19 PE.

show abstract

COVID-19 coagulopathy and thrombosis: Analysis of hospital protocols in response to the rapidly evolving pandemic

Cited by 15 publications

References 14 publications

Bleeding risk by intensity of anticoagulation in critically ill patients with COVID‐19: A retrospective cohort study

Bleeding risk by intensity of anticoagulation in critically ill patients with COVID‐19: A retrospective cohort study

Multicenter registry of United States emergency department patients tested for SARS‐CoV‐2

SARS-CoV-2 Infection: Modulator of Pulmonary Embolism Paradigm

Contact Info

Product

Resources

About