TY - JOUR
T1 - Nonadministration of pharmacologic venous thromboembolism prophylaxis is less common in hospitalized patients with COVID-19
AU - Varasteh Kia, Mujan
AU - Lau, Brandyn D.
AU - Owodunni, Oluwafemi P.
AU - Kraus, Peggy S.
AU - Holzmueller, Christine G.
AU - Hobson, Deborah B.
AU - Shaffer, Dauryne L.
AU - Streiff, Michael B.
AU - Haut, Elliott R.
N1 - Funding Information:
Drs. Haut and Streiff, Ms. Holzmueller, Ms. Shaffer and Mr. Lau were supported by contracts from PCORI entitled "Preventing Venous Thromboembolism: Empowering Patients and Enabling Patient-Centered Care via Health Information Technology" (CE-12-11-4489) and "Preventing Venous Thromboembolism (VTE): Engaging Patients to Reduce Preventable Harm from Missed/Refused Doses of VTE Prophylaxis" (DI-1603-34596) and Implementing Best-Practice, Patient-Centered Venous Thromboembolism (VTE) Prevention in Trauma Centers" (DI-2019C3-17859). Mr. Lau, Ms. Varasteh Kia, Ms. Holzmueller, Ms. Shaffer, and Drs. Streiff, Haut, and Owodunni were/are supported by a grant from the AHRQ (1R01HS024547) entitled "Individualized Performance Feedback on Venous Thromboembolism Prevention Practice," a contract from PCORI entitled "Preventing Venous Thromboembolism (VTE): Engaging Patients to Reduce Preventable Harm from Missed/Refused Doses of VTE Prophylaxis," and a grant from the NIH/NHLBI (R21HL129028) entitled "Analysis of the Impact of Missed Doses of Venous Thromboembolism Prophylaxis." Drs. Haut, Streiff, Owodunni, Mr. Lau, and Ms. Varasteh Kia are supported by a grant from the AHRQ (R18HS025341) titled "Disseminating an Evidence-based Venous Thromboembolism Prevention Bundle." Mr. Lau is supported by the Institute for Excellence in Education Berkheimer Faculty Education Scholar Grant and a contract (AD-1306-03980) from PCORI entitled "Patient Centered Approaches to Collect Sexual Orientation/Gender Identity Information in the Emergency Department." Dr. Haut is supported by a contract from the Patient-Centered Outcomes Research Institute (PCORI), "A Randomized Pragmatic Trial Comparing the Complications and Safety of Blood Clot Prevention Medicines Used in Orthopedic Trauma Patients" (PCS-1511-32745). Dr. Haut is a paid consultant and speaker for the "Preventing Avoidable Venous Thromboembolism—Every Patient, Every Time" VHA/Vizient IMPERATIV® Advantage Performance Improvement Collaborative. Dr. Haut receives royalties from Lippincott, Williams, Wilkins for a book—"Avoiding Common ICU Errors." Dr. Streiff has received research funding from Boehringer-Ingelheim, Janssen, Novo Nordisk, Roche and Sanofi and consulted for Bayer, Janssen, Pfizer and Portola and received honoraria for CME presentations from Bayer and Portola and has given expert witness testimony in various medical malpractice cases. Ms. Hobson and Dr. Kraus have nothing to disclose.
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.
PY - 2021/8
Y1 - 2021/8
N2 - Introduction: The incidence of venous thromboembolism (VTE) in patients hospitalized with COVID-19 is higher than most other hospitalized patients. Nonadministration of pharmacologic VTE prophylaxis is common and is associated with VTE events. Our objective was to determine whether nonadministration of pharmacologic VTE prophylaxis is more common in patients with COVID-19 versus other hospitalized patients. Materials and methods: In this retrospective cohort analysis of all adult patients discharged from the Johns hopkins hospital between Mar 1 and May 12, 2020, we compared demographic, clinical characteristics, VTE outcomes, prescription and administration of VTE prophylaxis between COVID-19 positive, negative, and not tested groups. Results: Patients tested positive for COVID-19 were significantly older, and more likely to be Hispanic, have a higher median body mass index, have longer hospital length of stay, require mechanical ventilation, develop pulmonary embolism and die (all p < 0.001). COVID-19 patients were more likely to be prescribed (aOR 1.51, 95% CI 1.38–1.66) and receive all doses of prescribed pharmacologic VTE prophylaxis (aOR 1.48, 95% CI 1.36–1.62). The number of patients who missed at least one dose of VTE prophylaxis and developed VTE was similar between the three groups (p = 0.31). Conclusions: It is unlikely that high rates of VTE in COVID-19 are due to nonadministration of doses of pharmacologic prophylaxis. Hence, we should prioritize research into alternative approaches to optimizing VTE prevention in patients with COVID-19.
AB - Introduction: The incidence of venous thromboembolism (VTE) in patients hospitalized with COVID-19 is higher than most other hospitalized patients. Nonadministration of pharmacologic VTE prophylaxis is common and is associated with VTE events. Our objective was to determine whether nonadministration of pharmacologic VTE prophylaxis is more common in patients with COVID-19 versus other hospitalized patients. Materials and methods: In this retrospective cohort analysis of all adult patients discharged from the Johns hopkins hospital between Mar 1 and May 12, 2020, we compared demographic, clinical characteristics, VTE outcomes, prescription and administration of VTE prophylaxis between COVID-19 positive, negative, and not tested groups. Results: Patients tested positive for COVID-19 were significantly older, and more likely to be Hispanic, have a higher median body mass index, have longer hospital length of stay, require mechanical ventilation, develop pulmonary embolism and die (all p < 0.001). COVID-19 patients were more likely to be prescribed (aOR 1.51, 95% CI 1.38–1.66) and receive all doses of prescribed pharmacologic VTE prophylaxis (aOR 1.48, 95% CI 1.36–1.62). The number of patients who missed at least one dose of VTE prophylaxis and developed VTE was similar between the three groups (p = 0.31). Conclusions: It is unlikely that high rates of VTE in COVID-19 are due to nonadministration of doses of pharmacologic prophylaxis. Hence, we should prioritize research into alternative approaches to optimizing VTE prevention in patients with COVID-19.
KW - COVID-19
KW - Deep vein thrombosis
KW - Missed doses
KW - Pulmonary embolism
KW - Thromboprophylaxis
KW - Venous thromboembolism
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U2 - 10.1007/s11239-021-02384-9
DO - 10.1007/s11239-021-02384-9
M3 - Article
C2 - 33507453
AN - SCOPUS:85099980758
VL - 52
SP - 471
EP - 475
JO - Journal of Thrombosis and Thrombolysis
JF - Journal of Thrombosis and Thrombolysis
SN - 0929-5305
IS - 2
ER -