COVID-19 coagulopathy and thrombosis: Analysis of hospital protocols in response to the rapidly evolving pandemic

As the Coronavirus disease 2019 (COVID-19) pandemic spread to the US, so too did descriptions of an associated coagulopathy and thrombotic complications. Hospitals created institutional protocols for inpatient management of COVID-19 coagulopathy and thrombosis in response to this developing data. We...

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Bibliographic Details
Published in:	Thrombosis research Vol. 196; pp. 355 - 358
Main Authors:	Parks, Anna L., Auerbach, Andrew D., Schnipper, Jeffrey L., Anstey, James E., Sterken, David G., Hecht, Todd E.H., Fang, Margaret C., Vaughn, Valerie M., Dunn, Andrew S., Linker, Anne S., Hunt, Daniel P., Choi, Justin J., Brotman, Daniel J., Streiff, Michael B., Mattison, Melissa L.P., Pappas, Matthew A., Greysen, S. Ryan, Hemsey, David F., Dapaah-Afriyie, Kwame, Ahuja, Neera, Collins, William J., Herzig, Shoshana J., Bhandari, Sanjay, Schumacher, Eric R., Duggirala, Vijay S., O'Leary, Kevin J., Menard, Geraldine E., Lin, Michael Y.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Ltd 01-12-2020
Subjects:	Academic Medical Centers Anticoagulants - administration & dosage Anticoagulants - adverse effects Anticoagulation Blood Coagulation - drug effects Clinical Protocols Coagulopathy Consensus Coronavirus COVID-19 - blood COVID-19 - complications COVID-19 - diagnosis COVID-19 - drug therapy Deep vein thrombosis (DVT) Healthcare Disparities - trends Humans Letter to the Editors-in-Chief Practice Patterns, Physicians' - trends Pulmonary embolism (PE) Pulmonary Embolism - blood Pulmonary Embolism - diagnosis Pulmonary Embolism - etiology Pulmonary Embolism - prevention & control Risk Assessment Risk Factors Thrombophilia - blood Thrombophilia - diagnosis Thrombophilia - etiology Thrombophilia - prevention & control Thrombosis Treatment Outcome United States Venous thromboembolism (VTE) Venous Thromboembolism - blood Venous Thromboembolism - diagnosis Venous Thromboembolism - etiology Venous Thromboembolism - prevention & control Venous Thrombosis - blood Venous Thrombosis - diagnosis Venous Thrombosis - etiology Venous Thrombosis - prevention & control United States Coronavirus Pulmonary embolism (PE) Deep vein thrombosis (DVT) Anticoagulation Thrombosis Venous thromboembolism (VTE) Coagulopathy
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Summary:	As the Coronavirus disease 2019 (COVID-19) pandemic spread to the US, so too did descriptions of an associated coagulopathy and thrombotic complications. Hospitals created institutional protocols for inpatient management of COVID-19 coagulopathy and thrombosis in response to this developing data. We collected and analyzed protocols from 21 US academic medical centers developed between January and May 2020. We found greatest consensus on recommendations for heparin-based pharmacologic venous thromboembolism (VTE) prophylaxis in COVID-19 patients without contraindications. Protocols differed regarding incorporation of D-dimer tests, dosing of VTE prophylaxis, indications for post-discharge pharmacologic VTE prophylaxis, how to evaluate for VTE, and the use of empiric therapeutic anticoagulation. These findings support ongoing efforts to establish international, evidence-based guidelines. •COVID-19 protocols agreed on heparin-based venous thromboembolism prophylaxis.•Disagreement on thrombosis risk and diagnosis, D-dimer, empiric anticoagulation•Cumulative incidence of COVID-19 did not correlate with specific recommendations.•Framework for frontline providers and hospitals to evaluate practices and outcomes
ISSN:	0049-3848 1879-2472
DOI:	10.1016/j.thromres.2020.09.018