Weight adjusted prophylactic to intermediate dosed thromboprophylaxis in COVID-19

Background : COVID-19 is frequently associated with venous thromboembolism (VTE), and the use of thromboprophylaxis has been suggested to improve hospitalized patients ' outcomes. We, therefore, intensified our thromboprophylactic protocol starting March 31st. Aims : We aimed to validate the implementation of an intensified thromboprophylactic protocol by reporting VTE incidence and safety while awaiting randomized controlled trials. Methods : On March 31st, 2020, we implemented an intensified thromboprophylactic protocol based on weight and disease severity (50 IU anti-Xa LMWH/kg, once daily at the ward, twice daily at the intensive care unit (ICU)). ICU patients were monitored daily with anti-Xa serum levels. Full therapeutic doses were restricted to patients with a prior indication for therapeutic anticoagulation or confirmed VTE. As early reports demonstrated high VTE incidence, screening with duplex ultrasound became standard of care in our center as soon as logistically possible. We excluded patients with a prior indication for therapeutic anticoagulation and incidental findings of COVID-19 for analysis. The ethical committee has approved this observational study. Results : We analyzed 412 symptomatic and confirmed Covid-19 cases, of which 116 were admitted to the ICU. All symptomatic VTE cases were reported, and 20% of all patients (38% of ICU patients) received screening with venous ultrasound. In 219 patients who received the standard dose of LMWH, 16 patients (7.3%) had VTE, 10 of which were symptomatic (4.6%) (Figure 1). In 193 patients who received intensified thromboprophylaxis, there were no symptomatic VTE cases, three incidental DVT cases (1.6%), and one incidental pulmonary embolism (0.5%). Interestingly, rates of major bleeding were low (Figure 2). Conclusions : In a large cohort of hospitalized patients with COVID-19, we report no symptomatic VTE after implementing systematic thromboprophylaxis with weight-adjusted prophylactic (ward) to intermediate (ICU), but not therapeutic doses of LMWH. This strategy was associated with a low risk of major bleeding.

Impact on aerosol generation of a mouthpiece designed to reduce droplet spread of covid-19 during upper gastrointestinal endoscopy, a single center randomized controlled trial

Introduction: In the continuous battle against the COVID-19 pandemic, searches to reduce the transmission during aerosol formatting procedures became key in health care. For upper gastrointestinal (GI) endoscopy, several typologies of face masks have been examined with various outcomes. Aims & Methods: We aimed to compare a commercially available droplet reduction mouthpiece B1 (Fujifilm Corporation, Tokyo, Japan) with a conventional one, in terms of aerosol formation both during and after upper GI endoscopy. Between March and April 2020 eighty COVID-19 negative patients referred for diagnostic upper GI endoscopy procedures, of which 7 also comprised through-the-scope balloon dilation, were included in the study and randomized in a 1:1 ratio between a conventional mouthpiece and the mouthpiece B1. Aerosol generation (0.3;0.5;1.0;3.0;5.0 and 10.0 micron particles) was measured using a Lasair® II Particle Counter (Particle Measuring Systems, Inc., United States) at different standardized time points (before endoscopy, 1-3-5 minutes during endoscopy, at the end and 1-3-5-10-15 minutes after endoscopy). Statistical analysis was performed using an unpaired student t-test to compare both groups, two-way ANOVA was used to test for differences over time and considered significant for a p<0.05. Ethical approval was obtained for this study (KU Leuven trial S65197) and every patient provided informed consent. Study was registered on clinicaltrials.gov (registration number NCT04864015). Results: There were no differences in baseline characteristics, type of sedation, insufflation rate or procedural duration between both groups. Comparison of aerosol formation at the different time-points showed no statistically significant difference for the 0.3;0.5;1.0;3.0;5.0 or 10.0 micron particles. Also the cumulative total number of particles over time were was not significantly different, see table 1. Conclusion: Compared to conventional mouthpieces, the commercially available mouthpiece B1 did not result in a statistically significant reduction in aerosol formation during routine upper GI endoscopy in this single center randomized trial.

BSGIE survey on COVID-19 and gastrointestinal endoscopy in Belgium : results and recommendations.

BACKGROUND AND AIMS: With the first wave of the COVID-19 pandemic declining, activities in the gastrointestinal clinic are being recommenced after a period of stringent measures. Since a second COVID-19 wave is not entirely ruled out health care professionals might remain faced with the need to perform endoscopic procedures in patients with a confirmed positive or unknown COVID-19 status. With this report we aim to provide a practical relevant overview of preparation and protective measures for gastroenterologists based on the currently available guidelines and our local experience and results of a national Belgian survey, to guarantee a fast recall of an adequate infection prevention if COVID-19 reoccurs. METHODS: From the 23rd of March 2020 and the 13th of May 2020 we performed a Pubmed, Embase and Medline search, resulting in 37 papers on COVID-19 and endoscopy. Additionally, we combined these data with data acquired from the national BSGIE survey amongst Belgian gastroenterologists. RESULTS: Based on 72 completed surveys in both university and non-university hospitals, the results show (1) a dramatic (<20%) or substantial (<50%) decrease of normal daily endoscopy in 74% and 22% of the units respectively, (2) a difference in screening and protective measures between university and non-university hospitals. These findings were subsequently compared with the current guidelines. CONCLUSION: Based on new data from the BSGIE survey and current guidelines we tried to realistically represent the current COVID-19 trends in protective measures, screening and indications for endoscopy and to provide a practical overview as preparation for a possible second wave.

Personal protection and delivery of rhinologic and endoscopic skull base procedures during the COVID-19 outbreak.

On March 11th 2020, the World Health Organization (WHO) declared COVID-19 pandemic, with subsequent profound impact on the entire health care system. During the COVID-19 outbreak, activities in the rhinology outpatient clinic and operation rooms are limited to emergency care only. Health care practitioners are faced with the need to perform rhinological and skull base emergency procedures in patients with a positive or unknown COVID-19 status. This article aims to provide recommendations and relevant information for rhinologists, based on the limited amount of (anecdotal) data, to guarantee high-quality patient care and adequate levels of infection prevention in the rhinology clinic.