ABSTRACT
Background: Patients on warfarin require regular international normalized ratio (INR) monitoring. The SARS-CoV- 2 pandemic may have substantially affected in-person medical visits and laboratory testing. However, it is not clear how warfarin monitoring practices have been affected by the pandemic, given the importance of tight INR control. Aim(s): To assess whether chronic warfarin management, as measured by INR testing frequency and time in therapeutic range (TTR), differed during the COVID-19 pandemic compared with the pre-pandemic period. Method(s): We identified all patients enrolled in an anticoagulation clinic associated with an urban academic medical between January 1, 2019 and May 31, 2021 with at least 2 INRs checked during this time period. We calculated frequency of INRs checked per month and TTR based on individual INR goals and compared the pre-pandemic (Jan 2019-Feb 2020) and pandemic (March 2020-May 2021) periods. INR frequency and TTR were modeled as a function of time period using Poisson and linear regressions respectively, accounting for repeated observations. Result(s): Of the 1052 patients included, 43.9% were women and average age was 66.3 years. Pre-pandemic, an average of 1.58 (95% CI 1.52-1.64) INRs were checked per month, as compared with 1.09 (95% CI 1.03-1.15) in the pandemic period (p< 0.001) (Figure 1). Average TTR per month was also calculated (Figure 2). On average, TTR was 56.8% (95% CI 54.9-58.8%) pre-pandemic compared to 39.4% (95% CI 37.5-41.5%) during the pandemic period (p < 0.001). (Table Presented) Conclusion(s): There was a significant decrease in the frequency of INR measurements as well as TTR during the pandemic. A number of factors may have contributed to this, including regulatory and logistical constraints on clinic and laboratory visits and patient anxiety about visiting medical facilities. Larger scale studies are warranted to further characterize pandemic effects on warfarin use and monitoring, as well as clinically significant outcomes of thrombosis and hemorrhage.
ABSTRACT
Introduction: The SARS-CoV2 pandemic impacted numerous aspects of medical practice, including continuingmedical education. In-person and single-institution educational formats could not address the challenges of socialdistancing, heterogeneous regional experiences, and continuously emerging data. The vulnerability of cancerpatients to SARS-CoV2 added further urgency to overcoming these barriers. To fulfill these unmet educational andpatient care needs, we established a novel cross-institutional trainee-driven, on-line collaborative for the purpose ofgenerating multidisciplinary seminars on emerging best practices for the acute management of patients with SARS-CoV2. Methods: The COVID Learning Initiative is currently managed by clinical trainees and faculty from 13 institutionsacross 10 states. Weekly Zoom conferences were led by a rotating team consisting of 2-3 fellows overseen by 4-5expert faculty from throughout the country. Format consisted of two 15-minute instructional segments presented bytrainees, followed by a concluding 30-minute faculty Q&A panel moderated by a trainee. Attendees completedbaseline demographics, SARS-CoV2 experience surveys, and pre/post conference knowledge questions.Conferences were recorded and archived to enhance access and dissemination of knowledge. Results: Within 6 weeks and beginning just 2 weeks after inception we produced five 1-hour-longmultidisciplinary video conferences covering emerging antiviral therapies, coagulopathy, pulmonary complications, provider resilience, and ethics of resource scarcity. On average, there were 100 participants per seminar. Post-conference questioning consistently demonstrated acquisition of knowledge across topics and disciplines. Attendeesalso improved in their self-assessed comfort managing multidisciplinary aspects of SARS-CoV2. Overall, presentingcollaborations involved 11 fellows and 28 faculty representing 6 medical specialties and 17 institutions. Severalcollaborations persisted, resulting in further dissemination of knowledge with tangible outcomes such as generationof peer-reviewed manuscripts. Conclusions: The COVID Learning Initiative demonstrated a novel continuing medical education platform capableof rapidly disseminating knowledge at a national scale, while realizing new opportunities for remote traineementoring and skills development. With initial feasibility and continued interest among participating institutions, COVID Learning Initiative plans to evolve to Fellows ACHIEVE: Alliance for Collaborative Hematology OncologyInter-Institutional Education through Videoconferencing to conduct an extended multi-institutional educational serieson adapting cancer management and training program best practices.