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Evaluation of a patient specific, targeted-intensity pharmacologic thromboprophylaxis protocol in hospitalized patients with COVID-19.
Farrar, Julie E; Trujillo, Toby C; Mueller, Scott W; Beltran, Lyra; Nguyen, Cecilia; Hassell, Kathryn; Kiser, Tyree H.
  • Farrar JE; Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Mobile, AL, USA.
  • Trujillo TC; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Pharmacy & Pharmaceutical Sciences, 12850 E. Montview Blvd., Aurora, CO, 80045, USA. toby.trujillo@cuanschutz.edu.
  • Mueller SW; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Pharmacy & Pharmaceutical Sciences, 12850 E. Montview Blvd., Aurora, CO, 80045, USA.
  • Beltran L; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Pharmacy & Pharmaceutical Sciences, 12850 E. Montview Blvd., Aurora, CO, 80045, USA.
  • Nguyen C; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Pharmacy & Pharmaceutical Sciences, 12850 E. Montview Blvd., Aurora, CO, 80045, USA.
  • Hassell K; Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
  • Kiser TH; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Pharmacy & Pharmaceutical Sciences, 12850 E. Montview Blvd., Aurora, CO, 80045, USA.
J Thromb Thrombolysis ; 53(2): 446-453, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1363762
ABSTRACT
Patients with COVID-19 are at higher risk of thrombosis due to the inflammatory nature of their disease. A higher-intensity approach to pharmacologic thromboprophylaxis may be warranted. The objective of this retrospective cohort study was to determine if a patient specific, targeted-intensity pharmacologic thromboprophylaxis protocol incorporating severity of illness, weight, and biomarkers decreased incidence of thrombosis in hospitalized patients with COVID-19. Included patients were hospitalized with COVID-19 and received thromboprophylaxis within 48 h of admission. Exclusion criteria included receipt of therapeutic anticoagulation prior to or within 24 h of admission, history of heparin-induced thrombocytopenia, extracorporeal membrane oxygenation, pregnancy, or incarceration. Per-protocol patients received thromboprophylaxis according to institutional protocol involving escalated doses of anticoagulants based upon severity of illness, total body weight, and biomarker thresholds. The primary outcome was thrombosis. Secondary outcomes included major bleeding, mortality, and identification of risk factors for thrombosis. Of 1189 patients screened, 803 were included in the final analysis. The median age was 54 (42-65) and 446 (55.5%) were male. Patients in the per-protocol group experienced significantly fewer thrombotic events (4.4% vs. 10.7%, p = 0.002), less major bleeding (3.1% vs. 9.6%, p < 0.001), and lower mortality (6.3% vs. 11.8%, p = 0.02) when compared to patients treated off-protocol. Significant predictors of thrombosis included mechanical ventilation and male sex. Post-hoc regression analysis identified mechanical ventilation, major bleeding, and D-dimer ≥ 1500 ng/mL FEU as significant predictors of mortality. A targeted pharmacologic thromboprophylaxis protocol incorporating severity of illness, body weight, and biomarkers appears effective and safe for preventing thrombosis in patients with COVID-19.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombosis / Venous Thromboembolism / COVID-19 / Anticoagulants Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: J Thromb Thrombolysis Journal subject: Vascular Diseases Year: 2022 Document Type: Article Affiliation country: S11239-021-02552-x

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombosis / Venous Thromboembolism / COVID-19 / Anticoagulants Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: J Thromb Thrombolysis Journal subject: Vascular Diseases Year: 2022 Document Type: Article Affiliation country: S11239-021-02552-x