Abstract
BackgroundThe recognition, prevention and treatment of venous thromboembolism (VTE) remains a major challenge in the face of the recent COVID-19 pandemic which has been associated with significant cardiovascular, renal, respiratory and hematologic complications related to hypercoagulability. There has been little literature thus far on the utility of screening ultrasound and the role of the clinical pharmacist in treating these patients.MethodsWe present a prospective pilot program of thirty-one consecutive COVID-19 patients who were provided four extremity screening ultrasounds for VTE on admission. This was coordinated by a clinical pharmacist as part of a multidisciplinary approach. Quantitative and qualitative data were recorded with the goal of describing the utility of the clinical pharmacist in ultrasound screening. Data collected include demographics, information on clinical symptoms or signs at presentation, and laboratory and radiologic results during the hospitalization from each individual electronic medical record.ResultsNine of the thirty-one patients presented with VTE. Of the nine patients, there were twenty-two total clotted vessels, all of which were asymptomatic. The clinical pharmacist, as the coordinator for a multidisciplinary COVID-19 associated coagulopathy management team, drafted a screening and treatment protocol for anticoagulation prophylaxis and therapy of VTE after ultrasound findings.ConclusionVTE screening of hospitalized COVID-19 patients reveals a significant number of asymptomatic VTEs and justifies diagnostic, prophylactic, and treatment measures coordinated by a clinical pharmacist.
Highlights
The recognition, prevention and treatment of venous thromboembolism (VTE) remains a major challenge in the face of the recent COVID-19 pandemic which has been associated with significant cardiovascular, renal, respiratory and hematologic complications related to hypercoagulability
The mortality and outcome for COVID-19 patients may improve with higher intensity VTE prophylaxis or full anticoagulation to prevent the formation of micro thromboemboli in the pulmonary vasculature [28,29,30,31,32,33,34,35,36,37,38,39,40,41,42]
We present a pilot experience of a prospective evaluation protocol for COVID-19 associated VTE coordinated by a clinical pharmacist
Summary
The recognition, prevention and treatment of venous thromboembolism (VTE) remains a major challenge in the face of the recent COVID-19 pandemic which has been associated with significant cardiovascular, renal, respiratory and hematologic complications related to hypercoagulability. Patients hospitalized due to an acute illness have an elevated risk of venous thromboembolism (VTE) while in-hospital and for up to 45 days after hospitalization [1,2,3,4,5,6,7,8,9]. The risk of VTE in a patient with an acute infectious disease rises up to 32 times that of the general hospitalized patients in some reports [4, 5, 11]. This risk is elevated in patients hospitalized due to COVID-19, yet the level of risk is not clearly defined. We hypothesize that severely ill COVID-19 patients in the intensive care unit (ICU) are at risk of VTE, and that COVID-19 patients hospitalized to the general floor can develop VTE without clinical signs or symptoms
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