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Side-Effects of COVID-19 on Patient Care: An INR Story.
Pearson, Lauren N; Johnson, Stacy A; Greene, Dina N; Chambliss, Allison B; Farnsworth, Christopher W; French, Deborah; Herman, Daniel S; Kavsak, Peter A; Merrill, Anna E; Lo, Sheng-Ying Margaret; Lyon, Martha E; SoRelle, Jeffrey A; Schmidt, Robert L.
  • Pearson LN; Department of Pathology, University of Utah, Salt Lake City, UT, USA.
  • Johnson SA; Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
  • Greene DN; Kaiser Permanente Washington, Washington, Renton, WA, USA.
  • Chambliss AB; Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
  • Farnsworth CW; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA.
  • French D; Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA, USA.
  • Herman DS; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
  • Kavsak PA; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
  • Merrill AE; Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
  • Lo SM; Division of Laboratory Medicine, Geisinger Medical Center, Danville, PA, USA.
  • Lyon ME; Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Saskatoon, Saskatchewan, CA, USA.
  • SoRelle JA; Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
  • Schmidt RL; Department of Pathology, University of Utah, Salt Lake City, UT, USA.
J Appl Lab Med ; 6(4): 953-961, 2021 07 07.
Article in English | MEDLINE | ID: covidwho-1147984
ABSTRACT

BACKGROUND:

Numerous studies have documented reduced access to patient care due to the COVID-19 pandemic, including access to diagnostic or screening tests, prescription medications, and treatment for an ongoing condition. In the context of clinical management for venous thromboembolism, this could result in suboptimal therapy with warfarin. We aimed to determine the impact of the pandemic on utilization of International Normalized Ratio (INR) testing and the percentage of high and low results.

METHODS:

INR data from 11 institutions were extracted to compare testing volume and the percentage of INR results ≥3.5 and ≤1.5 between a pre-pandemic period (January-June 2019, period 1) and a portion of the COVID-19 pandemic period (January-June 2020, period 2). The analysis was performed for inpatient and outpatient cohorts.

RESULTS:

Testing volumes showed relatively little change in January and February, followed by a significant decrease in March, April, and May, and then returned to baseline in June. Outpatient testing showed a larger percentage decrease in testing volume compared to inpatient testing. At 10 of the 11 study sites, we observed an increase in the percentage of abnormal high INR results as test volumes decreased, primarily among outpatients.

CONCLUSION:

The COVID-19 pandemic impacted INR testing among outpatients which may be attributable to several factors. Increased supratherapeutic INR results during the pandemic period when there was reduced laboratory utilization and access to care is concerning because of the risk of adverse bleeding events in this group of patients. This could be mitigated in the future by offering drive-through testing and/or widespread implementation of home INR monitoring.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Warfarin / International Normalized Ratio / Venous Thromboembolism / Patient Care / SARS-CoV-2 / COVID-19 / Anticoagulants Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: J Appl Lab Med Year: 2021 Document Type: Article Affiliation country: Jalm

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Warfarin / International Normalized Ratio / Venous Thromboembolism / Patient Care / SARS-CoV-2 / COVID-19 / Anticoagulants Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: J Appl Lab Med Year: 2021 Document Type: Article Affiliation country: Jalm