Document Type

Research Project

Publication Date

Spring 3-30-2022

Abstract

Surges of COVID-19 have been seen to place large numbers of patients into the ICU. Establishing standards of care is critical not only for patient care, but to also implement a baseline of therapy to build upon with future research. COVID-19 produces a hypercoagulable state resulting in higher occurrences of clotting such as deep vein thrombosis (DVT), and pulmonary embolism (PE). Anticoagulation medications thin the blood to combat this aspect of the disease from occurring but does so at the risk of increasing bleeding potential. The purpose of this study is to evaluate the risk/benefit of anticoagulation usage between ventilated and non-ventilated COVID-19 ICU patients as both bleeding and clotting are linked to worsened outcomes. A retrospective analysis reviewed 103 COVID (+) intensive care unit (ICU) patients with approved standardized COVID anticoagulation from August 2020 through January 2021 at a small community hospital. Patient data was obtained by navigating through Citrix Visual Apps including Pharmacy, NextGen EHR, and Paragon Clinician Hub. Pros and cons observed in EHR navigation were reflected upon in Chapter 5. Primary goal is to compare the endpoint of thrombotic events along with secondary outcomes of bleeding and overall mortality between ventilated and non-ventilated patients. Chi-square tests and two-sided t-tests were utilized in obtaining significance. Significance was defined as p<0.05 and confidence interval of 95%. This study found ventilated patients experienced significantly more clotting (30 vs 15, p = 0.0003) in addition to higher bleeding rates (14 vs 5; p = 0.0138) and worse mortality (24 vs 11; p = 0.0016). There were no significant differences with number of prophylactic or intermediate anticoagulants given between groups. Treatment heparin was used significantly more in the ventilated group, but this was due to the higher rates of thrombosis being treated. Apixaban treatment and enoxaparin intermediate dosing resulted in the highest prevalence of thrombotic events (30.3%, 29.41% prospectively) while heparin treatment accounted for the highest prevalence of bleeding events (17.39%). Overall, this study displays a potential need for higher anticoagulation in COVID-19 ICU ventilated patients at the risk of bleeding. Future studies required include regression analysis on treatment heparin PTT and enoxaparin Xa levels and associated thrombosis/bleeding events in ventilated patients.

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