ABSTRACT
BACKGROUND: The recognition, prevention and treatment of venous thromboembolism (VTE) remains a major challenge in the face of the recent COVID-19 pandemic which has been associated with significant cardiovascular, renal, respiratory and hematologic complications related to hypercoagulability. There has been little literature thus far on the utility of screening ultrasound and the role of the clinical pharmacist in treating these patients. METHODS: We present a prospective pilot program of thirty-one consecutive COVID-19 patients who were provided four extremity screening ultrasounds for VTE on admission. This was coordinated by a clinical pharmacist as part of a multidisciplinary approach. Quantitative and qualitative data were recorded with the goal of describing the utility of the clinical pharmacist in ultrasound screening. Data collected include demographics, information on clinical symptoms or signs at presentation, and laboratory and radiologic results during the hospitalization from each individual electronic medical record. RESULTS: Nine of the thirty-one patients presented with VTE. Of the nine patients, there were twenty-two total clotted vessels, all of which were asymptomatic. The clinical pharmacist, as the coordinator for a multidisciplinary COVID-19 associated coagulopathy management team, drafted a screening and treatment protocol for anticoagulation prophylaxis and therapy of VTE after ultrasound findings. CONCLUSION: VTE screening of hospitalized COVID-19 patients reveals a significant number of asymptomatic VTEs and justifies diagnostic, prophylactic, and treatment measures coordinated by a clinical pharmacist.
Subject(s)
Anticoagulants/adverse effects , COVID-19/blood , Drug Monitoring/methods , Enoxaparin/adverse effects , Hemorrhage/prevention & control , Heparin/adverse effects , SARS-CoV-2 , Thrombelastography , Thrombophilia/drug therapy , Adult , Aged , Aged, 80 and over , Algorithms , Anticoagulants/administration & dosage , Anticoagulants/therapeutic use , Blood Coagulation Tests , Blood Proteins/analysis , COVID-19/complications , COVID-19/therapy , Clinical Protocols , Critical Care , Enoxaparin/administration & dosage , Enoxaparin/therapeutic use , Female , Hemorrhage/chemically induced , Heparin/administration & dosage , Heparin/therapeutic use , Humans , Male , Middle Aged , Point-of-Care Testing , Postoperative Complications/epidemiology , Prospective Studies , Respiration, Artificial , Risk Factors , Thrombophilia/etiologySubject(s)
Anti-Bacterial Agents/adverse effects , Linear IgA Bullous Dermatosis/chemically induced , Prosthesis-Related Infections/drug therapy , Skin Diseases, Vesiculobullous/chemically induced , Vancomycin/adverse effects , Aged , Female , Humans , Linear IgA Bullous Dermatosis/pathology , Skin Diseases, Vesiculobullous/pathology , Treatment OutcomeABSTRACT
Metronidazole is commonly used in the treatment of anaerobic infections. While neuropathy is known to be associated with metronidazole, encephalopathy has been rarely reported. We herein present a case of metronidazole-induced encephalopathy presenting as frequent falls and slurred speech. Magnetic resonance imaging of the brain demonstrated T2/FLAIR hyperintensity in the dentate nuclei bilaterally. Soon after the discontinuation of metronidazole, dysarthria and dysmetria resolved. Metronidazole-induced encephalopathy should be considered in patients presenting with new neurologic symptoms after the initiation of metronidazole.
