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. 2020 Dec:196:355-358.
doi: 10.1016/j.thromres.2020.09.018. Epub 2020 Sep 16.

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

Anna L Parks  1 , Andrew D Auerbach  2 , Jeffrey L Schnipper  3 , James E Anstey  2 , David G Sterken  4 , Todd E H Hecht  5 , Margaret C Fang  6 ; Hospital Medicine Reengineering Network (HOMERuN)
Collaborators, Affiliations

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

Anna L Parks et al. Thromb Res. 2020 Dec.

Abstract

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.

Keywords: Anticoagulation; Coagulopathy; Coronavirus; Deep vein thrombosis (DVT); Pulmonary embolism (PE); Thrombosis; Venous thromboembolism (VTE).

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Dr. Fang reports that research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number K24HL141354. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Dr. Auerbach reports that research reported in this publication was supported by the Gordon and Betty Moore Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Gordon and Betty Moore Foundation.

Figures

Fig. 1
Fig. 1
The x-axis displays the proportion of protocols that addressed a clinical question. For protocols that addressed a clinical question, the proportion of protocols that supported a specific practice (“consensus”) is overlaid. Solid blue bars denote the proportion of protocols that addressed a clinical question with >50% consensus. Patterned blue bars denote the proportion of protocols that addressed a clinical question with <50% consensus. Grey bars denote the proportion of protocols that did not address a clinical question. Abbreviations: COVID-19 - Coronavirus disease 19, VTE - venous thromboembolism, LMWH - low-molecular-weight-heparin, UFH - unfractionated heparin, CBC - complete blood count, PT - prothrombin time, aPTT - activated partial thromboplastin time. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
See this image and copyright information in PMC

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