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

Anna L Parks; Andrew D Auerbach; Jeffrey L Schnipper; James E Anstey; David G Sterken; Todd E H Hecht; Margaret C Fang; Hospital Medicine Reengineering Network (HOMERuN)

doi:10.1016/j.thromres.2020.09.018

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

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

Authors

Anna L Parks¹, Andrew D Auerbach², Jeffrey L Schnipper³, James E Anstey², David G Sterken⁴, Todd E H Hecht⁵, Margaret C Fang⁶; Hospital Medicine Reengineering Network (HOMERuN)

Collaborators

Hospital Medicine Reengineering Network (HOMERuN):
Valerie M Vaughn⁷, Andrew S Dunn⁸, Anne S Linker⁸, Daniel P Hunt⁹, Justin J Choi¹⁰, Daniel J Brotman¹¹, Michael B Streiff¹², Melissa L P Mattison¹³, Matthew A Pappas¹⁴, S Ryan Greysen⁵, David F Hemsey¹⁵, Kwame Dapaah-Afriyie¹⁶, Neera Ahuja¹⁷, William J Collins¹⁷, Shoshana J Herzig¹⁸, Sanjay Bhandari¹⁹, Eric R Schumacher²⁰, Vijay S Duggirala²⁰, Kevin J O'Leary²¹, Geraldine E Menard²², Michael Y Lin²³

Affiliations

¹ Division of Hematology and Oncology, University of California, San Francisco, CA, USA.
² Division of Hospital Medicine, University of California, San Francisco, CA, USA.
³ Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁴ Division of Hospital Medicine, University of Wisconsin, Madison, WI, USA.
⁵ Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁶ Division of Hospital Medicine, University of California, San Francisco, CA, USA. Electronic address: Margaret.Fang@ucsf.edu.
⁷ Division of Hospital Medicine, University of Michigan, Ann Arbor, MI, USA.
⁸ Division of Hospital Medicine, Mount Sinai Health System, New York, NY, USA.
⁹ Division of Hospital Medicine, Emory University School of Medicine, Atlanta, GA, USA.
¹⁰ Division of Hospital Medicine, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA.
¹¹ Division of Hospital Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹² Division of Hematology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹³ Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
¹⁴ Division of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA.
¹⁵ Division of Hospital Medicine, University of North Carolina, Chapel Hill, NC, USA.
¹⁶ Division of Hospital Medicine, Alpert Medical School of Brown University (Miriam Hospital), Providence, RI, USA.
¹⁷ Division of Hospital Medicine, Stanford University School of Medicine, Stanford, CA, USA.
¹⁸ Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹⁹ Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
²⁰ Division of Hospital Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
²¹ Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
²² Division of General Internal Medicine and Geriatrics, Tulane University School of Medicine, New Orleans, LA, USA.
²³ Division of Hospital Medicine, Washington University School of Medicine in St. Louis, Saint Louis, MO, USA.

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).

Publication types

Letter

MeSH terms

Academic Medical Centers
Anticoagulants / administration & dosage*
Anticoagulants / adverse effects
Blood Coagulation / drug effects*
COVID-19 / blood
COVID-19 / complications
COVID-19 / diagnosis
COVID-19 Drug Treatment*
Clinical Protocols*
Consensus
Healthcare Disparities / trends
Humans
Practice Patterns, Physicians' / trends
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*
Treatment Outcome
United States
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*

Substances

Anticoagulants

Abstract

Publication types

MeSH terms

Substances

Grants and funding