{"id":63,"date":"2020-08-22T18:27:34","date_gmt":"2020-08-22T18:27:34","guid":{"rendered":"https:\/\/www.hospitalinnovate.org\/covid19\/?page_id=63"},"modified":"2022-05-20T21:40:57","modified_gmt":"2022-05-20T21:40:57","slug":"vte-overview","status":"publish","type":"page","link":"https:\/\/www.hospitalinnovate.org\/covid19\/clinical-pathways-and-documentation\/vte-overview\/","title":{"rendered":"VTE Overview"},"content":{"rendered":"<p>[vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221; equal_height=&#8221;yes&#8221; content_placement=&#8221;bottom&#8221; css=&#8221;.vc_custom_1601408973850{margin-top: 0px !important;margin-bottom: 0px !important;border-bottom-width: 4px !important;padding-top: 0px !important;padding-right: 20px !important;padding-bottom: 0px !important;padding-left: 20px !important;background-color: #f2f2f2 !important;border-bottom-color: #2c5d73 !important;border-bottom-style: solid !important;}&#8221;][vc_column width=&#8221;1\/2&#8243; css=&#8221;.vc_custom_1599239336771{padding-right: 20px !important;padding-left: 10px !important;}&#8221;][cesis_icon_paragraph i_size=&#8221;20&#8243; heading=&#8221;Prevention and Treatment of VTE &#8211; OVERVIEW&#8221; text=&#8221;&#8221; margin_top=&#8221;40&#8243; icon_color=&#8221;#f7941d&#8221; h_icon_color=&#8221;#f7941d&#8221; heading_color=&#8221;#f7941d&#8221; heading_h_color=&#8221;#f7941d&#8221; heading_f_size=&#8221;20px&#8221; heading_f_weight=&#8221;600&#8243; heading_l_height=&#8221;30px&#8221; heading_t_transform=&#8221;none&#8221; icon=&#8221;fa-droplet&#8221;][\/cesis_icon_paragraph][\/vc_column][vc_column width=&#8221;1\/2&#8243;][cesis_breadcrumb pos=&#8221;cesis_breadcrumb_right&#8221; force_font=&#8221;custom&#8221; bread_color=&#8221;#2c5d73&#8243; bread_hover_color=&#8221;#2c5d73&#8243; f_size=&#8221;10px&#8221; f_weight=&#8221;300&#8243; t_transform=&#8221;uppercase&#8221; margin_bottom=&#8221;20&#8243;][\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221; gap=&#8221;20&#8243; equal_height=&#8221;yes&#8221; css=&#8221;.vc_custom_1601409020186{margin-top: 0px !important;padding-top: 0px !important;padding-right: 20px !important;}&#8221;][vc_column width=&#8221;1\/4&#8243; css=&#8221;.vc_custom_1601409057795{margin-top: 0px !important;margin-right: px !important;margin-bottom: px !important;margin-left: px !important;border-left-width: 0px !important;padding-top: 20px !important;padding-right: 8px !important;padding-bottom: 8px !important;padding-left: 8px !important;background-color: #f5f5f5 !important;border-left-color: #f5f5f5 !important;border-left-style: solid !important;}&#8221; offset=&#8221;vc_hidden-xs&#8221;][cesis_icon i_size=&#8221;20&#8243; position=&#8221;i_float_left&#8221; margin_right=&#8221;10&#8243; icon_color=&#8221;#f7941d&#8221; icon=&#8221;fa-page&#8221;][vc_column_text font_size=&#8221;16px&#8221; text_resize=&#8221;yes&#8221; text_minimum=&#8221;10&#8243; line_height=&#8221;1.25em&#8221; css=&#8221;.vc_custom_1616613241528{margin-top: 0px !important;margin-right: 0px !important;margin-bottom: 0px !important;margin-left: 0px !important;}&#8221; font_color=&#8221;#2c5d73&#8243;]<strong>Clinical Pathways and Documentation<\/strong>[\/vc_column_text][vc_wp_custommenu nav_menu=&#8221;24&#8243;][cesis_line_divider width=&#8221;&#8221;][vc_column_text]<em>Last Updated: Mar. 23, 2021<\/em>[\/vc_column_text][\/vc_column][vc_column width=&#8221;3\/4&#8243; css=&#8221;.vc_custom_1601408993828{margin-top: 20px !important;padding-top: 8px !important;padding-right: 8px !important;padding-bottom: 8px !important;padding-left: 8px !important;border-radius: 4px !important;}&#8221;][vc_row_inner gap=&#8221;20&#8243; css=&#8221;.vc_custom_1600126612328{padding-left: 10px !important;}&#8221;][vc_column_inner width=&#8221;1\/2&#8243;][vc_column_text]<\/p>\n<h3><strong>Team Leads<\/strong><\/h3>\n<ul>\n<li>Anna Parks, MD (University of California, San Francisco School of Medicine)<\/li>\n<li>James Anstey, MD (University of California, San Francisco School of Medicine)<\/li>\n<li>Todd Hecht, MD (University of Pennsylvania School of Medicine)<\/li>\n<li>David Sterken, MD (University of Wisconsin School of Medicine and Public Health)<\/li>\n<li>Margaret Fang, MD, MPH (University of California, San Francisco School of Medicine)<\/li>\n<\/ul>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h3>Summary of venous and arterial thrombosis risk in COVID-19<\/h3>\n<p>Early reports suggested that hospitalized patients with coronavirus disease-19 (COVID-19) were at greatly increased risk of venous and arterial thrombosis (VTE and ATE) despite pharmacologic prophylaxis. As the pandemic wore on, published incidence rates declined from their peak at the beginning of the pandemic toward rates that remain elevated but less markedly so. For example, an early report demonstrated that approximately one-third of critically ill patients from 3 centers in the Netherlands had pulmonary embolism (PE), while a later paper from New York City reported a CVTE rate of 3.3%.<sup><a href=\"#notes\">1,2<\/a><\/sup> Additional data also confirmed that the risk of VTE after discharge appears closer to published rates in non-COVID-19 patients.<sup><a href=\"#notes\">3<\/a><\/sup> Nevertheless, these reports, coupled with laboratory data demonstrating markedly elevated D-dimer, ferritin and other markers of activated hemostasis, prompted consideration of aggressive prophylactic and treatment strategies. In addition, concerns about infection control and limited personal protective equipment led to changes in how VTE is diagnosed, such as using point-of-care testing rather than formal radiographic diagnosis. Hospitals, including HOMERuN consortium members, developed COVID-19 thrombosis guidelines early in the pandemic to aid in clinical decision-making. These guidelines reflected the early uncertainties about VTE risk and optimal management and demonstrated variability across institutions.<sup><a href=\"#notes\">4<\/a><\/sup><\/p>\n<p>More than a year later, the results of clinical trials testing various VTE prevention and management strategies are starting to emerge. In addition, international professional societies have developed evidence-based guidelines. We recommend that HOMERuN collaborative members access trusted external resources summarized in the table below for the most updated guidance on COVID-19 and thrombosis.[\/vc_column_text][\/vc_column_inner][vc_column_inner width=&#8221;1\/2&#8243;][vc_column_text]<\/p>\n<h3>Current guideline recommendations for venous thromboembolism prevention with COVID-19<\/h3>\n<table border=\"1\" cellpadding=\"5px\">\n<tbody>\n<tr>\n<td><strong>Organization<\/strong><\/td>\n<td><strong>Available at<\/strong><\/td>\n<\/tr>\n<tr>\n<td>American College of Chest Physicians<\/td>\n<td><a href=\"https:\/\/doi.org\/10.1016\/j.chest.2020.05.559\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/doi.org\/10.1016\/j.chest.2020.05.559<\/a><\/td>\n<\/tr>\n<tr>\n<td>International Society on Thrombosis and Hemostasis<\/td>\n<td><a href=\"https:\/\/doi.org\/10.1111\/jth.14929\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/doi.org\/10.1111\/jth.14929<\/a><\/td>\n<\/tr>\n<tr>\n<td>American Society of Hematology<\/td>\n<td><a href=\"https:\/\/doi.org\/10.1182\/bloodadvances.2020003763\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/doi.org\/10.1182\/bloodadvances.2020003763<\/a><\/td>\n<\/tr>\n<tr>\n<td>Anticoagulation Forum<\/td>\n<td><a href=\"https:\/\/doi.org\/10.1007\/s11239-020-02138-z\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/doi.org\/10.1007\/s11239-020-02138-z<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h3><strong>VTE Group Publication<\/strong><\/h3>\n<p>Parks AL, Auerbach AD, Schnipper JS, et al; the Hospital Medicine Reengineering Network (HOMERuN). <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC9071149\/\" target=\"_blank\" rel=\"noopener\">Venous thromboembolism (VTE) prevention and diagnosis in COVID-19: practice patterns and outcomes at 33 hospitals<\/a>. <em>PLOS ONE<\/em>. 2022;17(5):e0266944.<\/p>\n<p>Parks AL, Auerbach AD, Schnipper JL, et al. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32977136\/\" target=\"_blank\" rel=\"noopener noreferrer\">COVID-19 coagulopathy and thrombosis: analysis of hospital protocols in response to the rapidly evolving pandemic<\/a>. <em>Thromb Res<\/em>. 2020;196:355-358.[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner][vc_column_inner offset=&#8221;vc_hidden-lg vc_hidden-md vc_hidden-sm&#8221;][vc_wp_custommenu nav_menu=&#8221;24&#8243; el_class=&#8221;subNavButton2&#8243;][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221;][vc_column][cesis_line_divider width=&#8221;&#8221;][vc_column_text font_size=&#8221;10px&#8221; css=&#8221;.vc_custom_1616612248669{padding-top: 20px !important;padding-right: 20px !important;padding-bottom: 20px !important;padding-left: 20px !important;background-color: #f9f9f9 !important;}&#8221;]<a name=\"notes\"><\/a><\/p>\n<ol>\n<li>Klok FA, Kruip MJHA, van der Meer NJM, et al. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7146714\/\" target=\"_blank\" rel=\"noopener noreferrer\">Incidence of thrombotic complications in critically ill ICU patients with COVID-19<\/a>. <em>Thromb Res.<\/em> 2020;191:145-147. doi:10.1016\/j.thromres.2020.04.013<\/li>\n<li>Goyal P, Choi JJ, Pinheiro LC, et al. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32302078\/\" target=\"_blank\" rel=\"noopener noreferrer\">Clinical characteristics of COVID-19 in New York City.<\/a> <em>N Engl J Med.<\/em> 2020;382(24):2372-2374. doi:10.1056\/NEJMc2010419<\/li>\n<li>Roberts LN, Whyte MB, Georgiou L, et al. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32746455\/\" target=\"_blank\" rel=\"noopener noreferrer\">Postdischarge venous thromboembolism following hospital admission with COVID-19<\/a>. <em>Blood<\/em>. 2020;136(11):1347-1350. doi:10.1182\/blood.2020008086<\/li>\n<li>Parks AL, Auerbach AD, Schnipper JL, et al. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32977136\/\" target=\"_blank\" rel=\"noopener noreferrer\">COVID-19 coagulopathy and thrombosis: analysis of hospital protocols in response to the rapidly evolving pandemic<\/a>. <em>Thromb Res.<\/em> 2020;196:355-358.<\/li>\n<\/ol>\n<p>[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221; 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