{"id":269,"date":"2020-09-04T19:23:35","date_gmt":"2020-09-04T19:23:35","guid":{"rendered":"https:\/\/www.hospitalinnovate.org\/covid19\/?p=269"},"modified":"2020-09-21T23:26:13","modified_gmt":"2020-09-21T23:26:13","slug":"7who-should-receive-extended-vte-prophylaxis-post-discharge-and-what-is-the-optimal-strategy","status":"publish","type":"post","link":"https:\/\/www.hospitalinnovate.org\/covid19\/2020\/09\/04\/7who-should-receive-extended-vte-prophylaxis-post-discharge-and-what-is-the-optimal-strategy\/","title":{"rendered":"07. Who should receive extended VTE prophylaxis post-discharge, and what is the optimal strategy?"},"content":{"rendered":"

[vc_row full_width=”stretch_row_content_no_spaces” equal_height=”yes” content_placement=”bottom” css=”.vc_custom_1599596618526{margin-top: 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;}”][vc_column width=”2\/3″ css=”.vc_custom_1599247143020{padding-right: 20px !important;padding-left: 10px !important;}”][vc_custom_heading text=”Prevention and Treatment of Venous Thromboembolism Key Clinical Questions” font_container=”tag:h2|text_align:left|color:%23f7941d” use_theme_fonts=”yes” css=”.vc_custom_1599247161415{margin-top: 0px !important;padding-top: 40px !important;}”][\/vc_column][vc_column width=”1\/3″][vc_column_text]<\/p>\n

Home<\/a> \/ VTE Overview<\/a> \/ VTE Clinical Questions<\/a><\/p>\n

[\/vc_column_text][\/vc_column][\/vc_row][vc_row full_width=”stretch_row_content_no_spaces” gap=”20″][vc_column width=”3\/4″ css=”.vc_custom_1599594983880{padding: 20px !important;}”][vc_custom_heading source=”post_title” use_theme_fonts=”yes”][vc_column_text]<\/p>\n

a. HOMERuN institutions<\/strong><\/h3>\n

Sixty-two percent of institutions recommended consideration of post-discharge pharmacologic VTE prophylaxis. There was little consensus on recommended agent, dose, and duration. There was little agreement on criteria for selecting patients for post-discharge prophylaxis. The most common indication cited was to continue pharmacologic prophylaxis post-discharge if patients had received intensified prophylaxis dosing or empiric treatment dosing while hospitalized (38%). Other criteria included considering whether the patient had ongoing immobility or had an elevated D-dimer at discharge.[\/vc_column_text][vc_row_inner gap=”30″ css=”.vc_custom_1599595011579{padding: 20px !important;}”][vc_column_inner width=”1\/2″][vc_column_text]<\/p>\n

b. What is Known<\/strong><\/h3>\n

Extended duration prophylaxis beyond hospitalization has been shown to benefit some high-risk\u00a0surgical\u00a0patients. In general, evidence to date for post-discharge prophylaxis for medically ill patients generally demonstrates no difference in overall survival or rates of pulmonary embolism but does show a reduced risk of symptomatic VTE. This is countered by an increased risk of major bleeding (RR 2.09, 95% 1.33-3.27).16<\/a><\/sup>[\/vc_column_text][\/vc_column_inner][vc_column_inner width=”1\/2″][vc_column_text]<\/p>\n

c. What is Not Known<\/strong><\/h3>\n

The risks and benefits of post-discharge prophylaxis for patients with COVID-19 specifically, and whether these differ from medically ill patients generally, remain unknown. The optimal criteria for identifying patients at high risk of VTE post-discharge who warrant pharmacologic prophylaxis remain unknown. There is also uncertainty regarding the optimal regimen, including agent, dosing, and duration.[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][vc_column width=”1\/4″ css=”.vc_custom_1600127084438{border-top-width: 1px !important;border-right-width: 1px !important;border-bottom-width: 1px !important;border-left-width: 4px !important;padding-top: 20px !important;padding-right: 20px !important;padding-bottom: 20px !important;padding-left: 20px !important;border-left-color: #2c5d73 !important;border-left-style: solid !important;border-right-color: #2c5d73 !important;border-right-style: solid !important;border-top-color: #2c5d73 !important;border-top-style: solid !important;border-bottom-color: #2c5d73 !important;border-bottom-style: solid !important;border-radius: 4px !important;}”][vc_raw_html]JTVCdWx0aW1hdGVfcG9zdF9saXN0JTIwaWQlM0QlMjIxMjQlMjIlNUQ=[\/vc_raw_html][vc_wp_custommenu nav_menu=”3″ title=”VTE Links” el_class=”subNavButton”][\/vc_column][\/vc_row][vc_row full_width=”stretch_row_content_no_spaces”][vc_column][cesis_line_divider width=””][vc_column_text font_size=”10px” css=”.vc_custom_1600730766563{padding-top: 20px !important;padding-right: 20px !important;padding-bottom: 20px !important;padding-left: 20px !important;background-color: #f9f9f9 !important;}”]<\/a><\/p>\n

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    1. Sch\u00fcnemann HJ, Cushman M, Burnett AE, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients<\/a>. Blood Adv<\/em>. 2018;2(22):3198-3225. doi:10.1182\/bloodadvances.2018022954<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n

      [\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"

      Nineteen percent of protocols recommended standard pharmacologic VTE prophylaxis dosing for all COVID-19 patients regardless of estimated VTE risk. Ten percent recommended…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[],"_links":{"self":[{"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/posts\/269"}],"collection":[{"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/comments?post=269"}],"version-history":[{"count":9,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/posts\/269\/revisions"}],"predecessor-version":[{"id":632,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/posts\/269\/revisions\/632"}],"wp:attachment":[{"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/media?parent=269"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/categories?post=269"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/tags?post=269"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}