COVID-19 is associated with significant derangement of hemostasis, which can manifest in the form of a venous thromboembolism (VTE). Therefore, it is critical to quickly identify patients at risk and initiate thromboprophylaxis to prevent life-threatening thrombotic events. A new innovative tool from DynaMed® Decisions, COVID-19: Anticoagulation Management and Thromboprophylaxis for VTE, takes the guesswork out of this clinical decision. Here are two scenarios exhibiting this DynaMed Decisions tool in action.
Lorelai, a 35-year-old female with no significant past medical history, is evaluated at her primary care physician's office after the onset of chills, sore throat and rhinorrhea. Symptoms developed several days after she attended a speed dating event at a local bar. Medications include only a 2,000-unit vitamin D supplement and 400 mg ibuprofen as needed. Vital signs are as follows: BP 132/84, HR 84, RR 18, SpO2 97%. Cardiopulmonary exam is notable only for scattered rhonchi on auscultation. There is no calf tenderness or swelling. A rapid COVID-19 PCR test is positive in the office.
Her doctor is aware that COVID-19 has been shown to induce coagulopathy and wonders whether she should start her patient on a blood thinner as a preventive measure. Using the DynaMed Decisions COVID-19 anticoagulation tool, the doctor finds the answer she is looking for — Outpatients with no specific concern for venous thromboembolism should not receive a prophylactic blood thinner. Further, the physician learns that based on the latest professional guidance, patients in an outpatient setting should not initiate or adjust anticoagulant dosing solely due to a new diagnosis of COVID-19.
Lorelai’s 62-year-old father, Richard, unfortunately caught COVID-19 from Lorelai after the family’s weekly dinner. With his family’s encouragement, he presents to the emergency department of their local hospital after he develops a fever, cough and dyspnea.
His medical history is notable for hypertension, obesity and hyperlipidemia for which he takes lisinopril 40 mg daily and atorvastatin 80 mg daily. On exam by an emergency physician, he is found to be hypoxic and tachypneic, COVID-19 test is positive, and he is admitted to the hospital on one of the medical floors as he is not thought to need ICU-level care.
The intern on the medical team enters his room to review his chart. He notices that the patient is already taking antithrombotic medication, and there is not any particular concern for a venous thromboembolism. He is aware that some new evidence has been recently published that suggests a possible benefit for therapeutic-dose anticoagulation in an acute care (non-ICU) setting. However, he is not sure of the current state of professional guidelines in this area. Furthermore, he is hesitant regarding whether any type of even prophylactic anticoagulation is appropriate, knowing that this patient's prothrombin time (PT) and partial thromboplastin time (PTT) values were slightly abnormal on admission.
Using the DynaMed Decisions tool, the intern reads that, although recent trial data suggest some possible benefit of therapeutic-dose anticoagulation compared to prophylactic-dose anticoagulation, no guidelines recommend therapeutic-dose anticoagulation as standard of care in an inpatient, non-ICU care setting. In addition, supplementary information in the tool informs him that abnormal lab values (including PT/INR or PTT) without bleeding are not contraindications to prophylactic-dose anticoagulation. The clinician decides to initiate prophylactic-dose low-molecular-weight heparin (LMWH) for the patient, feeling confident that he is selecting the appropriate dosing.
With the innovative DynaMed Decisions COVID-19 anticoagulation tool, physicians have the most current clinical practice guidance for anticoagulation specific to their patient, allowing confident decision making and meaningful patient care.
