Continuous Infusion Low-Dose Unfractionated Heparin for the Management of Hypercoagulability Associated With COVID-19.

INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) is associated with severe hypercoagulability. There is currently limited evidence supporting the routine use of therapeutic anticoagulation in the setting of COVID-19. OBJECTIVES: The primary objective was to compare the incidence of thromboembolic events in adult patients with COVID-19 treated with an unfractionated heparin (UFH) infusion versus prophylactic dose anticoagulation. Secondary objectives included exploration of the efficacy and safety of an UFH infusion through the evaluation of organ function and incidence of minor and major bleeding. METHODS: Retrospective observational cohort study with propensity score matching of COVID-19 patients who received an UFH infusion targeting an aPTT between 40 and 60 seconds. RESULTS: Fifty-six patients were included in this study. There was no difference in the composite of thromboembolic events comprised of venous thromboembolism, arterial thrombosis, and catheter-related thrombosis between the UFH and control group (17.9% vs. 3.6%, P = 0.19). There was a significant increase in median D-dimer concentrations from day 1 to day 7 in the control group (475 ng/mL [291-999] vs. 10820 ng/mL [606-21033], P = 0.04). Patients treated with UFH had a higher incidence of minor bleeding (35.7% vs. 0%, P < 0.005) and required more units of packed red blood cell transfusion (0.8 units ± 1.6 vs. 0 units, P = 0.01). CONCLUSION: Continuous infusion of UFH for patients with COVID-19 infection did not decrease the overall incidence of thromboembolic complications. UFH was associated with stabilization of D-dimer concentrations and increased rates of minor bleeding and transfusions.

Pain Intensity: How Press Ganey Survey Domains Correlate in Total Knee Arthroplasty Patients.

Decreasing postoperative pain for total knee arthroplasty (TKA) patients has been an area of continued effort for healthcare providers. These efforts have been incentivized by legislative reform, which ties reimbursement for hospitals and providers to patient perception of care. Press Ganey (PG) surveys quantify patient satisfaction, and the "pain management" domain is thought to be the best metric for assessing pain intensity. Therefore, these responses are important, as they are used to guide further improvements in healthcare delivery. This study analyzes which PG survey domains are truly associated with pain intensity in the immediate postoperative period following TKA. We queried our PG database for all primary TKA patients between November 2012 and January 2015, yielding a total of 214 patients. Multivariate regression analysis was performed utilizing pain intensity as the dependent variable. Predictor variables included body mass index (BMI), Charlson's comorbidity index, opioid consumption, and PG survey domains. Patient ratings of "communication with doctors" (B = 58.147; p = 0.001), "responsiveness of hospital staff" (B = - 62.663; p = 0.041), "communication about medicines" (B= -45.037; p < 0.001), and "hospital environment" (B = 69.342; p = 0.017) were associated with patient pain intensity. We found survey domains, other than "pain management," were associated with pain intensity. Efforts to improve outcomes and satisfaction should focus on staff education and communication. The current method for measuring patient satisfaction and reimbursement should be critically assessed and redesigned to better reflect true patient experiences.