Anticoagulation

Argatroban for Anticoagulation in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation in Coronavirus Disease 2019

From Critical Care Explorations. In this study, the authors conclude that argatroban, with or without aspirin, is an effective anticoagulation strategy for patients who require venovenous extracorporeal membrane oxygenation support secondary to coronavirus disease 2019.

Regarding anticoagulation strategies, is there a role for tissue plasminogen activator (tPA)? If so, what is the indication for it and who would you use it on?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on July 14, 2021

What is the most recent evidence on anticoagulation dosing for patients with COVID-19, specifically prophylactic versus treatment and duration of therapy?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on July 14, 2021

VTE and COVID-19; Anti-Xa Monitoring in VTE Prophylaxis: Is There a Role?

Controversies in VTE Prophylaxsis; Xa Monitoring for VTE Prophylaxis. This is SCCM curated COVID-19 microlearning content.

Curriculum Topic: Cardiovascular Complications: Venous Thromboembolism, Myocarditis, and Shock

Online Letter to the Editor: The Janus Face of Coronavirus Disease 2019–Associated Coagulopathy

From Critical Care Medicine. This Online Letter to the Editor is in response to an article by Doyle et al. entitled “A comparison of thrombosis and hemorrhage rates in patients with severe respiratory failure due to coronavirus disease 2019 and influenza requiring extracorporeal membrane oxygenation.”

Can you expand on the use of anticoagulation in patients who have been diagnosed with COVID-19?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on May 12th, 2021

CDC Resources: Hematology

SCCM’s COVID-19 Rapid Resource Center now links to pertinent content from the Centers for Disease Control and Prevention (CDC). These resources are categorized as Hematology

Is Microthrombosis the Main Pathology in Coronavirus Disease 2019 Severity?—A Systematic Review of the Postmortem Pathologic Findings

From Critical Care Explorations.  In this systematic review, the authors attempted to retrieve and report the findings of postmortem studies including the histopathologic data of deceased coronavirus disease 2019 patients and to review the manifestations of coronavirus disease 2019–associated thrombotic pathologies reported in the recent literature. Diffuse alveolar damage was the most predominant feature in the lungs of coronavirus disease 2019 patients who underwent postmortem assessment. Widespread pulmonary microthrombosis and extensive pulmonary angiogenesis, in addition to frequent pulmonary and extrapulmonary microthrombotic and thromboembolic findings in patients with coronavirus disease 2019, appear to be consistent with the disease-specific hypercoagulability.

Can you discuss the use of anticoagulation for blood clot prevention in COVID-19 patients?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on April 14th, 2021

Should anticoagulation or antiplatelet therapy be used for patients with COVID-19? Should these patients be empirically anticoagulated? How is your institution handling this?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on March 10, 2021

Anticoagulation Therapy in Patients With Coronavirus Disease 2019: Results From a Multicenter International Prospective Registry (Health Outcome Predictive Evaluation for Corona Virus Disease 2019 [HOPE-COVID19])

From Critical Care Medicine. The authors evaluate the efficacy of anticoagulation in coronavirus disease 2019 hospitalized patients and its impact on survival.

Which populations should be anticoagulated? What is the procedure for anticoagulation and how long should it take?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on February 24, 2021
 

Can children be anticoagulated or only adults?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on February 24, 2021

Can antiplatelets be administered at the same time as anticoagulation in patients with COVID-19?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on February 24, 2021

How should patients be weaned off mechanical ventilation? When should they be weaned and how long should weaning take?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on February 24, 2021

D-dimer and Death in Critically Ill Patients With Coronavirus Disease 2019

From Critical Care Medicine.  In a large multicenter cohort study of critically ill patients with coronavirus disease 2019, the authors found higher D-dimer levels were independently associated with a greater risk of death.

The Association of Preinfection Daily Oral Anticoagulation Use and All-Cause in Hospital Mortality From Novel Coronavirus 2019 at 21 Days: A Retrospective Cohort Study

From Critical Care Explorations. In this retrospective study, the authors sought to understand the association of preinfection daily oral anticoagulation use and the short-term mortality of patients hospitalized with coronavirus disease 2019.

Is there any consensus about prophylactic anticoagulation in patients without known venous thromboembolism?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on January 13, 2021.

Integral Use of Thromboelastography With Platelet Mapping to Guide Appropriate Treatment, Avoid Complications, and Improve Survival of Patients With Coronavirus Disease 2019–Related Coagulopathy

From Critical Care Explorations

In this study, the authors round that thromboelastography with platelet mapping better characterizes the spectrum of coronavirus disease 2019 coagulation-related abnormalities and may guide more tailored, patient-specific therapies in thostudyse infected with coronavirus disease 2019.

How do we prevent VTEs and how do we survey for them? Should patients receive standard prophylaxis? Should all ventilated patients receive full-dose anticoagulation? What are your practices and how have you approached this at your center?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on December 9, 2020.

Thromboembolism, Hypercoagulopathy, and Antiphospholipid Antibodies in Critically Ill Coronavirus Disease 2019 Patients: A Before and After Study of Enhanced Anticoagulation

From Critical Care Explorations

In this study, the authors sought to determine the prevalence of thrombotic events, functional coagulation tests, inflammatory biomarkers, and antiphospholipid antibodies before and after enhanced anticoagulation in critically ill coronavirus disease 2019 patients.

Clinical Outcomes With the Use of Prophylactic Versus Therapeutic Anticoagulation in Coronavirus Disease 2019

From Critical Care Explorations

In this study, the authors found an increase in inhospital mortality was observed among patients on preemptive therapeutic anticoagulation.

What are the indications for post-discharge thromboprophylaxis?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on November 4, 2020.

What is your experience with COVID-19 patients and ECMO?

Despite remdesivir, dexamethasone, and twice-daily anticoagulation, a patient’s condition continues to deteriorate. The patient is intubated, and every possible ventilation mode has been tried. The P/F ratio is decreasing, and pressure ventilation is not working. What is your experience with COVID-19 patients and ECMO? This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on November 4, 2020.

Which medications are used for a hemodynamically unstable intubated patient who is progressing toward or has developed acute respiratory distress syndrome? Are remdesivir or steroids used? What about anticoagulation, given the high risk of thrombosis?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on November 4, 2020.

What is double anticoagulation prophylaxis?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on October 14, 2020.

Are you using typical DVT prophylaxis or something more, such as therapeutic anticoagulation?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on October 14, 2020.

What is double anticoagulation prophylaxis?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on October 14, 2020.

Are you using typical DVT prophylaxis or something more, such as therapeutic anticoagulation?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on October 14, 2020.

How should anticoagulation be approached in the critically ill patient with COVID-19?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on September 9, 2020.

Letter to Editor: In Response to "Coagulopathy of Coronavirus Disease 2019"

From Critical Care Medicine. This Letter to the Editor is in response to the article "Coagulopathy of Coronavirus 2019" by Iba et a.

Higher Intensity Thromboprophylaxis Regimens and Pulmonary Embolism in Critically Ill Coronavirus Disease 2019 Patients

From Critical Care Medicine. In this study from Belgium, the authors assessed the role of thromboprophylaxis regimens on the occurrence of pulmonary embolism in coronavirus disease 2019 patients.

Incidence of Venous Thromboembolism in Critically Ill Coronavirus Disease 2019 Patients Receiving Prophylactic Anticoagulation

From Critical Care Medicine. Deep venous thrombosis is very common in critically ill patients with coronavirus disease 2019, so the authors describe the prevalence of venous thromboembolism in critically ill patients receiving different regimens of prophylactic anticoagulation.

What are the options for diagnosis, workup, and treatment for a hypercoagulable state?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on July 8th, 2020.

Subcutaneous Enoxaparin Safely Facilitates Bedside Sustained Low-Efficiency Hemodialysis in Hypercoagulopathic Coronavirus Disease 2019 Patients - A Proof-of-Principle Trial

This study describes a simple and safe protocol of anticoagulation with low molecular weight heparin (LMWH) in combination with bedside sustained low efficiency hemodialysis (SLED) in COVID-19 patients.

Can you discuss coagulability issues?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on May 13th, 2020.

Coagulopathy of Coronavirus Disease 2019

From Critical Care Medicine. Recent studies have reported a high incidence of thrombotic events in COVID-19. However, the significance of thromboembolic complications has not been widely appreciated. The purpose of this review is to provide current knowledge of this serious problem.

What are your thoughts on anticoagulation treatment?

In this question and answer webcast series, attendees had an opportunity to pose questions about managing critically ill patients with COVID-19 and other issues.

What is the recommended role of serial laboratory studies, including troponin, creatin kinase and D-dimer in the management of a hypercoagulable state?

Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered.