SCIENTIFIC
Adherence to Antithrombotic Therapy Guidelines in COVID-19 Patients at a Major Medical Center in West Virginia
AUTHORS : Saranya Dinesan , MBBS 1
Mohammad Ali Kali , BS 2 Steven J . Jubelirer , MD 3 Elaine Davis , RN , EdD 2 Christine A . Welch , M . S . 2
1
Charleston Area Medical Center
2
Charleston Area Medical Center , Institute for Academic Medicine , Center for Health Services and Outcomes Research
3
Charleston Area Medical Center , Hematology and Oncology
INTRODUCTION
The coronavirus disease of 2019 ( COVID-19 ) pandemic created unprecedented challenges for healthcare systems worldwide . Methods of diagnosis and modalities of treatment had continued to evolve throughout the pandemic . The complexity of the etiology and presentation of polymerase chain reaction ( PCR ) positive , symptomatic COVID-19 made it particularly challenging to treat and manage . The unique structure of this novel virus can cause robust autoimmune and inflammatory responses in infected patients , most commonly presenting as pulmonary and extra-pulmonary manifestations . 1 Immobility and other physiologic factors can place these patients in a hypercoagulable state and make them more prone to thrombosis ; hence , consideration for initiating appropriate antithrombotic therapy was recognized early in the pandemic . 2
COVID-19 presents with different constellations of symptoms and might affect multiple organs and vital systems because of systematic proinflammatory and autoimmune responses . 3 COVID-19 treatment requires a multidisciplinary approach and the involvement of multispecialty clinical teams , including infectious disease , pulmonary critical care , cardiology , hematology , and others . Recommendations for an-
ABSTRACT
INTRODUCTION Guidelines for the appropriate use of antithrombotics in hospitalized patients diagnosed with the coronavirus disease of 2019 ( COVID-19 ) in the non-intensive care unit ( ICU ) setting have been published . Adherence to these guidelines was evaluated at the Charleston Area Medical Center ( CAMC ) in West Virginia .
METHODS In a retrospective study , data from patients treated from February 1 , 2022 , to July 10 , 2022 , and entered into the CAMC COVID-19 registry were reviewed . Exclusionary criteria included treatment in an ICU , and those with comorbidities that would justify the use of unfractionated heparin . Collected data included patient demographics , comorbidities , and treatments related to antithrombotic therapy .
RESULTS There were 512 patients in the registry . Of those , 76.56 % received non-ICU care , with 255 remaining for analysis after other exclusionary
tithrombotic prophylaxis have been made for COVID-19 patients . 4 The National Institute of Health published guidelines suggesting that : 1 ) aspirin should not be used for hospitalized , nonpregnant adults without evidence of venous thromboembolism ; 2 ) antiplatelet therapy should not be used to prevent arterial thrombosis outside the usual standard of care ; 3 ) low molecular weight heparin ( LMWH ) or unfractionated heparin ( UFH ) is preferred over oral anticoagulants ; and 4 ) when heparin is used , LMWH is preferred over UFH . 4
Hospitalized patients , such as those with COVID-19 , are prone to deep vein thrombosis ( DVT ) or pulmonary embolism ( PE ) because of immobility . 5 Other risk factors include genetic predisposition , cancer , surgery , and trauma . 5 The Centers for Disease Control and Prevention estimate that DVT or PE occurs in one to two persons per 1,000 each year . 6 The United States ’ mortality from DVT / PE is estimated to be 10 criteria were applied . Subjects were assigned to two groups based on antithrombotic guideline adherence : Group A ( 58.82 %) received treatment consistent with guidelines , and Group B ( 41.18 %) did not .
DISCUSSION Despite published guidelines specific to this patient population , there were missed opportunities to better manage antithrombotic therapies in this high-risk and complex patient population .
CONCLUSION Our study results revealed the majority of patients in a non-ICU setting received treatment consistent with guidelines . As part of a teaching institution , we are responsible for leading by example by utilizing published guidelines established to improve the quality of care . The results of this project justify a comprehensive quality improvement initiative around antithrombotic guideline adherence in COVID-19 and other complex conditions .
to 30 % in the first month after diagnosis , while sudden death occurs in about 25 % of those affected . 6 Nearly one-half of those diagnosed with a DVT will have long-term complications termed post-thrombotic syndrome , which can include swelling , pain , discoloration , and scaling in the affected limb . 6 Low molecular weight heparin is preferred over UFH because less frequent monitoring is required , and there is a lower risk for heparin-induced thrombocytopenia ( HIT ). 7
The American Society of Hematology guideline panel made a conditional recommendation for therapeutic-intensity anticoagulation over prophylactic-intensity anticoagulation in acutely ill medical patients with COVID-19 while acknowledging that individualized decision-making is required . 8 At present , there is no direct high-certainty evidence comparing different types of anticoagulants in patients with COVID-19 . Unfractionated or low
20 • www . wvsma . org