The Collateral Benefit of COVID Pandemic: Improved Pharmacological Venous Thromboembolism Prophylaxis Practices in Non-COVID Patients

Abstract

Murat Özdede,1 Alper Tuna Güven,2 Damla Karadeniz Güven,3 Oğuz Abdullah Uyaroğlu,1 Mine Durusu Tanriover1 1Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of General Internal Medicine, Ankara, Turkey; 2Başkent University Adana Hospitals, Department of Internal Medicine, Division of General Internal Medicine, Adana, Turkey; 3Adana City Hospital, Department of Pulmonology, Adana, TurkeyCorrespondence: Alper Tuna Güven, Başkent University Adana Hospitals, Department of Internal Medicine, Division of General Internal Medicine, Yüreğir, Adana, Turkey, Tel [phone], Email [email protected]: COVID-19 creates a hypercoagulable state with a wide spectrum of clinical manifestations. Of those, venous thromboembolism (VTE) is prevalent, and numerous studies have highlighted the importance of VTE prophylaxis. Pre-pandemic VTE prophylaxis practices have already been poor, despite guidelines. We hypothesized that the gap between guidelines and practices might have been closed due to increased awareness.Materials and Methods: Non-COVID-19 patients hospitalized in the internal medicine ward of a university hospital between January 1st, 2021, and June 30th, 2021, were assessed. VTE risk and thromboprophylaxis requirements were assessed using the Padua Prediction Score (PPS). The results were compared with the findings of the study conducted in the same setting before the pandemic.Results: A total of 267 patients were included, and 81 patients (30.3%) received prophylaxis. A total of 128 patients’ (47.9%) PPS was ≥ 4, and 69 patients (53.9%) received prophylaxis; 12 low-risk patients (8.6%) received prophylaxis although it was not indicated. Compared to the pre-pandemic figures, both appropriate prophylaxis use and overuse rates have risen. While the increment rate of appropriate prophylaxis was statistically significant, the increment rate of overuse did not reach statistical significance. Patients hospitalized for infectious diseases and respiratory failure were more likely to receive appropriate prophylaxis.Conclusion: We have demonstrated a significant increase in appropriate pharmacologic prophylaxis rates among high-risk patients. Besides all the collateral damage the pandemic has created, it might also have brought collateral benefits with regards to VTE prophylaxis.Keywords: COVID-19, venous thromboembolism, risk assessment, quality of health care, quality improvement

Keywords

• covid-19
• venous thromboembolism
• risk assessment
• quality of health care
• quality improvement