ABSTRACT
Background: The COVID pandemic caused delays in a number of referral pathways, including lung cancer. The UKintroduced the first national lockdown on March 2020 as hospitals were inundated with COVID patients. As a resultpatients with early signs of lung cancer may have avoided healthcare settings. CT based lung cancer screening wasalso introduced in the Trust in 2021 targeting people aged 55 and 75 with a significant smoking history. All patientsreferred urgently in July 2020 and July 2021 were included in this study. Result(s): Of the 124 referrals on July 2021, 9 of the patients were referred from the screening programme, 3 ofwhom were diagnosed with cancer with only 1 eligible for treatment. Discussion(s):View inline There was no significant change in the overall proportion of cancer diagnoses between 2020 and 2021. However patients presented with more advanced stages of cancer and fewer were elligible for treatment in 2020 compared to 2021. It also took longer to start treatment in 2020 as compared to 2021. These findings may reflect delays in presentation in the early stages of the pandemic in 2020 as people avoided healthcare settings, as well as delays to diagnose and initiate treatment in the conditions of extreme pressure on respiratory services at the time. By 2021, reduction in the number of COVID cases allowed a phased return from lockdown with more patients with suspicious symptoms presenting at an earlier stage and thus eligible for treatment.
ABSTRACT
Introduction: The current COVID-19 research has calculated VTE incidence in critical care which is 25%. We designed an increased dose thromboprophylaxis protocol based on D-dimer and weight for all patients that were admitted to respiratory wards. Objectives: To assess the incidence of pulmonary embolism pre and post protocol and to assess 30 days mortality rate. Methods: We evaluated retrospectively the incidence of pulmonary embolism for all COVID 19 patients admitted to respiratory wards before and after the modified protocol. Results: View inline Discussion: Our thromboprophylaxis protocol change demonstrated a decrease in incidence of PE, fewer ITU admissions, and a reduced length of stay. We suggest that in the pre-protocol population, the rapid deterioration of patients requiring invasive ventilation may be related to embolic phenomenon and microvascular thrombi rather than progression of COVID-19.There was one clinically significant bleed in Pre-protocol group. Therefore, it is essential to consider escalated thromboprophylaxis for all patients admitted to hospital with suspected or confirmed COVID-19 infection. With the still significant rate of PE, and lack of significant bleeding in the post protocol group, a randomised controlled trial of higher thromboprophylaxis versus treatment dose anticoagulation is now required.