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Venous thromboembolism (VTE) prevention and diagnosis in COVID-19: Practice patterns and outcomes at 33 hospitals.
Parks, Anna L; Auerbach, Andrew D; Schnipper, Jeffrey L; Bertram, Amanda; Jeon, Sun Y; Boyle, Bridget; Fang, Margaret C; Gadrey, Shrirang M; Siddiqui, Zishan K; Brotman, Daniel J.
  • Parks AL; Division of Hematology and Hematologic Malignancies, Department of Medicine, University of Utah, Salt Lake City, UT, United States of America.
  • Auerbach AD; Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America.
  • Schnipper JL; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States of America.
  • Bertram A; Division of Hospital Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America.
  • Jeon SY; Division of Geriatrics, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA, United States of America.
  • Boyle B; Division of Hospital Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America.
  • Fang MC; Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America.
  • Gadrey SM; Division of General, Geriatric, Palliative and Hospital Medicine, University of Virginia, Charlottesville, VA, United States of America.
  • Siddiqui ZK; Division of Hospital Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America.
  • Brotman DJ; Division of Hospital Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America.
PLoS One ; 17(5): e0266944, 2022.
Article in English | MEDLINE | ID: covidwho-1910586
ABSTRACT

BACKGROUND:

Early reports of increased thrombosis risk with SARS-CoV-2 infection led to changes in venous thromboembolism (VTE) management. Real-world data on the prevalence, efficacy and harms of these changes informs best practices.

OBJECTIVE:

Define practice patterns and clinical outcomes related to VTE diagnosis, prevention, and management in hospitalized patients with coronavirus disease-19 (COVID-19) using a multi-hospital US sample.

METHODS:

In this retrospective cross-sectional study of 1121 patients admitted to 33 hospitals, exposure was dose of anticoagulant prescribed for VTE prophylaxis (standard, intensified, therapeutic), and primary outcome was VTE (pulmonary embolism [PE] and deep vein thrombosis [DVT]); secondary outcomes were PE, DVT, arterial thromboembolism (ATE), and bleeding events. Multivariable logistic regression models accounting for clustering by site and adjusted for risk factors were used to estimate odds ratios (ORs). Inverse probability weighting was used to account for confounding by indication.

RESULTS:

1121 patients (mean age 60 ± 18, 47% female) admitted with COVID-19 between February 2, 2020 and December 31, 2020 to 33 US hospitals were included. Pharmacologic VTE prophylaxis was prescribed in 86%. Forty-seven patients (4.2%) had PE, 51 (4.6%) had DVT, and 23 (2.1%) had ATE. Forty-six patients (4.1%) had major bleeding and 46 (4.1%) had clinically relevant non-major bleeding. Compared to standard prophylaxis, adjusted odds of VTE were 0.67 (95% CI 0.21-2.1) with no prophylaxis, 1.0 (95% CI 0.06-17) with intensified, and 3.0 (95% CI 0.89-10) with therapeutic. Adjusted odds of bleeding with no prophylaxis were 5.6 (95% CI 3.0-11) and 5.3 (95% CI 3.0-10) with therapeutic (no events on intensified dosing).

CONCLUSIONS:

Therapeutic anticoagulation was associated with a 3-fold increased odds of VTE and 5-fold increased odds of bleeding. While higher bleeding rates with high-intensity prophylaxis were likely due to full-dose anticoagulation, we conclude that high thrombosis rates were due to clinical concern for thrombosis before formal diagnosis.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pulmonary Embolism / Venous Thromboembolism / COVID-19 Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0266944

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pulmonary Embolism / Venous Thromboembolism / COVID-19 Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2022 Document Type: Article Affiliation country: Journal.pone.0266944