Extended Venous Thromboembolism Prophylaxis in Medically Ill Patients: An NATF Anticoagulation Action Initiative

Barkoudah, Ebrahim; Piazza, Gregory; Hecht, Todd E.H.; Grant, Paul; Deitelzweig, Steven; Fang, Margaret C.; Fanikos, John; Kao, Cheng-Kai; Barnes, Geoffrey D.; Chen, Thomas; Ramishvili, Téa; Schnipper, Jeffrey L.; Goldstein, Jennifer N.; Ruff, Christian T.; Kaatz, Scott; Schwartz, Aviva; Connors, Jean M.; Goldhaber, Samuel Z.

doi:10.1016/j.amjmed.2019.12.001

Cited by 17 publications

(36 citation statements)

References 115 publications

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“…[2][3][4] Hospitalization as a result of medical illness is associated with increased risk of VTE, which is highest for the first 6 weeks and persists for 3 months. [10][11][12] Thromboprophylaxis with low molecular weight heparin (LMWH) reduces the risk of VTE in acutely ill hospitalized medical patients by 50%, [11][12][13] and all adult patients are routinely assessed for their risk of VTE and considered for LMWH prophylaxis on admission to our hospital. Meta-analysis of thromboprophylaxis for 28 to 45 days after discharge in medical patients (LMWH, rivaroxaban, betrixaban) has been shown to reduce the risk of VTE by 40%, but it doubles the risk of major or fatal bleeding 14 and is currently not recommended at our hospital in line with national guidance.…”

Section: Introductionmentioning

confidence: 99%

Incidence of symptomatic, image-confirmed venous thromboembolism following hospitalization for COVID-19 with 90-day follow-up

et al. 2020

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Although COVID-19 has been reported to be associated with high rates of venous thromboembolism (VTE), the risk of VTE and bleeding after hospitalization for COVID-19 remains unclear, and the optimal hospital VTE prevention strategy is not known. We collected retrospective observational data on thrombosis and bleeding in 303 consecutive adult patients admitted to the hospital for at least 24 hours for COVID-19. Patients presenting with VTE on admission were excluded. Data were collected until 90 days after admission or known death by using medical records and an established national VTE network. Maximal level of care was ward based in 78% of patients, with 22% requiring higher dependency care (12% noninvasive ventilation, 10% invasive ventilation). Almost all patients (97.0%) received standard thromboprophylaxis or were already receiving therapeutic anticoagulation (17.5%). Symptomatic image-confirmed VTE occurred in 5.9% of patients during index hospitalization, and in 7.2% at 90 days after admission (23.9% in patients requiring higher dependency care); half the events were isolated segmental or subsegmental defects on lung imaging. Bleeding occurred in 13 patients (4.3%) during index hospitalization (1.3% had major bleeding). The majority of bleeds occurred in patients on the general ward, and 6 patients were receiving treatment-dose anticoagulation, highlighting the need for caution in intensifying standard thromboprophylaxis strategies. Of 152 patients discharged from the hospital without an indication for anticoagulation, 97% did not receive thromboprophylaxis after discharge, and 3% received 7 days of treatment with low molecular weight heparin after discharge. The rate of symptomatic VTE in this group at 42 days after discharge was 2.6%, highlighting the need for large prospective randomized controlled trials of extended thromboprophylaxis after discharge in COVID-19.

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Section: Introductionmentioning

confidence: 99%

Incidence of symptomatic, image-confirmed venous thromboembolism following hospitalization for COVID-19 with 90-day follow-up

et al. 2020

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“…6 These insights are key to understanding who potentially may benefit from prevention strategies, given that limited evidence exists to help guide which patients with COVID-19 should be offered VTE prophylaxis initially or after hospitalization and at what anticoagulation intensity. 7 To address these knowledge gaps, we evaluated the rate of VTE among a large, ethnically diverse cohort of adults hospitalized with COVID-19 compared with matched control participants without COVID-19 and also identified predictors of VTE in patients with COVID-19.…”

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confidence: 99%

COVID-19 and Risk of VTE in Ethnically Diverse Populations

Go¹,

Reynolds²,

Tabada³

et al. 2021

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Background Limited existing data suggest the novel coronavirus disease 2019 (Covid-19) may increase risk for venous thromboembolism (VTE) but information from large, ethnically diverse populations with appropriate controls are lacking. Research Question Does the rate of VTE among adults hospitalized with Covid-19 differ from matched hospitalized controls without Covid-19? Study Design and Methods We conducted a retrospective study among hospitalized adults with laboratory-confirmed Covid-19 and hospitalized adults without evidence of Covid-19 matched on age, gender, race/ethnicity, acute illness severity, and month of hospitalization between February-August 2020 from two integrated healthcare delivery systems with 36 hospitals. Outcomes included VTE (deep venous thrombosis or pulmonary embolism ascertained using diagnosis codes combined with validated natural language processing algorithms applied to electronic health records) and death from any cause at 30 days. Fine and Gray hazards regression was performed to evaluate the association of Covid-19 with VTE after accounting for competing risk of death and residual differences between groups, as well as identifying predictors of VTE in patients with Covid-19. Results We identified 6,319 adults with Covid-19 and 6,319 matched adults without Covid-19, with mean (SD) age of 60.0 (17.2) years, 46% women, 53.1% Hispanic, 14.6% Asian/Pacific Islander and 10.3% Black. During 30-day follow-up, 313 validated VTE (160 Covid-19, 153 controls) and 1172 deaths (817 Covid-19, 355 controls) occurred. Adults with Covid-19 had a more than threefold adjusted risk of VTE (adjusted hazard ratio 3.48, 95% Confidence Interval 2.03-5.98) compared with matched controls. Predictors of VTE in Covid-19 patients included age ≥55 years, Black race, prior VTE, diagnosed sepsis, prior moderate or severe liver disease, body mass index ≥40 kg/m 2 , and platelet count >217 k/mcL. Interpretation Among ethnically diverse hospitalized adults, Covid-19 infection increased the risk of VTE, and selected patient characteristics were associated with higher thromboembolic risk in the setting of Covid-19.

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“…Moreover, following hospitalization, many elderly patients continue to have limited mobility. Those discharged to nursing home care are at up to a 30-fold higher risk of developing a VTE than the general population [ 202 ].…”

Section: Coating Materials Selectionmentioning

confidence: 99%

Addressing the Needs of the Rapidly Aging Society through the Development of Multifunctional Bioactive Coatings for Orthopedic Applications

Mastnak

Maver

Finšgar

2022

IJMS

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The unprecedented aging of the world’s population will boost the need for orthopedic implants and expose their current limitations to a greater extent due to the medical complexity of elderly patients and longer indwelling times of the implanted materials. Biocompatible metals with multifunctional bioactive coatings promise to provide the means for the controlled and tailorable release of different medications for patient-specific treatment while prolonging the material’s lifespan and thus improving the surgical outcome. The objective of this work is to provide a review of several groups of biocompatible materials that might be utilized as constituents for the development of multifunctional bioactive coatings on metal materials with a focus on antimicrobial, pain-relieving, and anticoagulant properties. Moreover, the review presents a summary of medications used in clinical settings, the disadvantages of the commercially available products, and insight into the latest development strategies. For a more successful translation of such research into clinical practice, extensive knowledge of the chemical interactions between the components and a detailed understanding of the properties and mechanisms of biological matter are required. Moreover, the cost-efficiency of the surface treatment should be considered in the development process.

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Extended Venous Thromboembolism Prophylaxis in Medically Ill Patients: An NATF Anticoagulation Action Initiative

Cited by 17 publications

References 115 publications

Incidence of symptomatic, image-confirmed venous thromboembolism following hospitalization for COVID-19 with 90-day follow-up

Incidence of symptomatic, image-confirmed venous thromboembolism following hospitalization for COVID-19 with 90-day follow-up

COVID-19 and Risk of VTE in Ethnically Diverse Populations

Addressing the Needs of the Rapidly Aging Society through the Development of Multifunctional Bioactive Coatings for Orthopedic Applications

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