Lynnea Schultz1, Tammy J Bungard2, Elizabeth Mackay3, Pawandeep Gill4, Micheal Guirguis5. 1. , PharmD, ACPR, is with the University of Alberta Hospital, Edmonton, Alberta. 2. , BSP, PharmD, is with the Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta. 3. , MD, FRCPC, MPH, is with the University of Calgary, Cummings School of Medicine, Peter Lougheed Centre, Calgary, Alberta. 4. , PharmD, ACPR, is with Alberta Health Services and Covenant Health, Edmonton, Alberta. 5. , BScPharm, PhD, is with the University of Alberta Hospital - Edmonton Zone, Alberta Health Services, Edmonton, Alberta.
Abstract
Background: COVID-19 causes a hypercoagulable state and increases the risk of venous thromboembolism (VTE). Objectives: The primary objective was to identify VTE prevalence among patients with COVID-19 in one Canadian province. Secondary objectives were to identify the prevalence of bleeding, describe anticoagulation prescribing practices, and identify factors contributing to VTE in these patients. Methods: Adult patients admitted to Alberta hospitals between March and December 2020 with COVID-19 who had a length of stay of at least 72 hours were included in this retrospective study. VTE, bleeding events, and comorbidities were defined by International Classification of Diseases and Related Health Problems, 10th Revision codes. Cases of VTE and controls (no VTE) were matched on the basis of age older than 60 years, active cancer, and length of stay for the full cohort, as well as for a subgroup of patients with d-dimer data available, to assess for factors associated with VTE. Results: A total of 2544 patients were included. Median age was 66 years, 1461 patients (57.4%) were male, median weight was 77.7 kg, and median d-dimer level on admission was 1.00 mg/L. The prevalence of VTE was 3.7% (n = 93) and that of major and clinically relevant non-major bleeding was 4.9% (n = 125). Of the total population, 1224 patients (48.1%) had standard prophylactic-dose anticoagulation, 460 (18.1%) received only higher-dose anticoagulation, 248 (9.7%) received both prophylactic- and higher-dose anticoagulation, and 612 (24.1%) had no anticoagulation data. Logistic regression showed that only the presence of d-dimer above 3 mg/L was associated with a significant odds ratio for VTE (7.04, 95% confidence interval 2.43-20.84). Conclusions: VTE prevalence among patients with COVID-19 was higher than baseline prevalence in Alberta. Analysis of prescribing practices demonstrated that a large proportion of patients received higher-dose anticoagulation. 2022 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.
Background: COVID-19 causes a hypercoagulable state and increases the risk of venous thromboembolism (VTE). Objectives: The primary objective was to identify VTE prevalence among patients with COVID-19 in one Canadian province. Secondary objectives were to identify the prevalence of bleeding, describe anticoagulation prescribing practices, and identify factors contributing to VTE in these patients. Methods: Adult patients admitted to Alberta hospitals between March and December 2020 with COVID-19 who had a length of stay of at least 72 hours were included in this retrospective study. VTE, bleeding events, and comorbidities were defined by International Classification of Diseases and Related Health Problems, 10th Revision codes. Cases of VTE and controls (no VTE) were matched on the basis of age older than 60 years, active cancer, and length of stay for the full cohort, as well as for a subgroup of patients with d-dimer data available, to assess for factors associated with VTE. Results: A total of 2544 patients were included. Median age was 66 years, 1461 patients (57.4%) were male, median weight was 77.7 kg, and median d-dimer level on admission was 1.00 mg/L. The prevalence of VTE was 3.7% (n = 93) and that of major and clinically relevant non-major bleeding was 4.9% (n = 125). Of the total population, 1224 patients (48.1%) had standard prophylactic-dose anticoagulation, 460 (18.1%) received only higher-dose anticoagulation, 248 (9.7%) received both prophylactic- and higher-dose anticoagulation, and 612 (24.1%) had no anticoagulation data. Logistic regression showed that only the presence of d-dimer above 3 mg/L was associated with a significant odds ratio for VTE (7.04, 95% confidence interval 2.43-20.84). Conclusions: VTE prevalence among patients with COVID-19 was higher than baseline prevalence in Alberta. Analysis of prescribing practices demonstrated that a large proportion of patients received higher-dose anticoagulation. 2022 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.
Authors: Russell A Trigonis; Daniel B Holt; Rebecca Yuan; Asma A Siddiqui; Mitchell K Craft; Babar A Khan; Rajat Kapoor; Omar Rahman Journal: Crit Care Med Date: 2020-09 Impact factor: 9.296
Authors: Ewan C Goligher; Charlotte A Bradbury; Bryan J McVerry; Patrick R Lawler; Jeffrey S Berger; Michelle N Gong; Marc Carrier; Harmony R Reynolds; Anand Kumar; Alexis F Turgeon; Lucy Z Kornblith; Susan R Kahn; John C Marshall; Keri S Kim; Brett L Houston; Lennie P G Derde; Mary Cushman; Tobias Tritschler; Derek C Angus; Lucas C Godoy; Zoe McQuilten; Bridget-Anne Kirwan; Michael E Farkouh; Maria M Brooks; Roger J Lewis; Lindsay R Berry; Elizabeth Lorenzi; Anthony C Gordon; Tania Ahuja; Farah Al-Beidh; Djillali Annane; Yaseen M Arabi; Diptesh Aryal; Lisa Baumann Kreuziger; Abi Beane; Zahra Bhimani; Shailesh Bihari; Henny H Billett; Lindsay Bond; Marc Bonten; Frank Brunkhorst; Meredith Buxton; Adrian Buzgau; Lana A Castellucci; Sweta Chekuri; Jen-Ting Chen; Allen C Cheng; Tamta Chkhikvadze; Benjamin Coiffard; Aira Contreras; Todd W Costantini; Sophie de Brouwer; Michelle A Detry; Abhijit Duggal; Vladimír Džavík; Mark B Effron; Heather F Eng; Jorge Escobedo; Lise J Estcourt; Brendan M Everett; Dean A Fergusson; Mark Fitzgerald; Robert A Fowler; Joshua D Froess; Zhuxuan Fu; Jean P Galanaud; Benjamin T Galen; Sheetal Gandotra; Timothy D Girard; Andrew L Goodman; Herman Goossens; Cameron Green; Yonatan Y Greenstein; Peter L Gross; Rashan Haniffa; Sheila M Hegde; Carolyn M Hendrickson; Alisa M Higgins; Alexander A Hindenburg; Aluko A Hope; James M Horowitz; Christopher M Horvat; David T Huang; Kristin Hudock; Beverley J Hunt; Mansoor Husain; Robert C Hyzy; Jeffrey R Jacobson; Devachandran Jayakumar; Norma M Keller; Akram Khan; Yuri Kim; Andrei Kindzelski; Andrew J King; M Margaret Knudson; Aaron E Kornblith; Matthew E Kutcher; Michael A Laffan; Francois Lamontagne; Grégoire Le Gal; Christine M Leeper; Eric S Leifer; George Lim; Felipe Gallego Lima; Kelsey Linstrum; Edward Litton; Jose Lopez-Sendon; Sylvain A Lother; Nicole Marten; Andréa Saud Marinez; Mary Martinez; Eduardo Mateos Garcia; Stavroula Mavromichalis; Daniel F McAuley; Emily G McDonald; Anna McGlothlin; Shay P McGuinness; Saskia Middeldorp; Stephanie K Montgomery; Paul R Mouncey; Srinivas Murthy; Girish B Nair; Rahul Nair; Alistair D Nichol; Jose C Nicolau; Brenda Nunez-Garcia; John J Park; Pauline K Park; Rachael L Parke; Jane C Parker; Sam Parnia; Jonathan D Paul; Mauricio Pompilio; John G Quigley; Robert S Rosenson; Natalia S Rost; Kathryn Rowan; Fernanda O Santos; Marlene Santos; Mayler O Santos; Lewis Satterwhite; Christina T Saunders; Jake Schreiber; Roger E G Schutgens; Christopher W Seymour; Deborah M Siegal; Delcio G Silva; Aneesh B Singhal; Arthur S Slutsky; Dayna Solvason; Simon J Stanworth; Anne M Turner; Wilma van Bentum-Puijk; Frank L van de Veerdonk; Sean van Diepen; Gloria Vazquez-Grande; Lana Wahid; Vanessa Wareham; R Jay Widmer; Jennifer G Wilson; Eugene Yuriditsky; Yongqi Zhong; Scott M Berry; Colin J McArthur; Matthew D Neal; Judith S Hochman; Steven A Webb; Ryan Zarychanski Journal: N Engl J Med Date: 2021-08-04 Impact factor: 176.079