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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

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martes, 13 de octubre de 2020

VTE and COVID-19

ST.EMLYN´S
St. Emlyn´s - By Dan Horner - October 12, 2020
That’s a leading question. Of course you would...
And what should we be doing?
I think that’s still tricky. But we are in a better position than last time and I think we can use this new evidence to agree on some issues
  • First, it is clear (and has been for some time) that all patients admitted to hospital who are unwell with COVID-19 should undergo risk assessment for VTE and should receive pharmacological thromboprophylaxis if safe. If community hubs and ‘hospital at home’ services continue to expand, this assessment may need to be extended outside the front door. 
  • Second, in those patients who are prescribed thromboprophylaxis, weight-based dosing algorithms should be strongly considered. There appears to be no clinical evidence of superiority for intermediate dosing strategies over a standard, licensed weight-based approach. I would extend this logic to patients admitted to intensive care. 
  • Third, we should ensure these patients are managed in line with the emerging evidence base outside of anticoagulation. Immunomodulatory agents clearly have face validity in this cohort. Before we weigh up the merits of unproven dose escalations of anticoagulants that we know will cause predictable harm, we must ensure that hypoxaemic patients have received dexamethasone. In the future this will also apply to any other therapies that have been studied and proven effective within the context of large, well conducted randomised controlled trials. 
  • Fourth we must continue to offer research opportunity. All our patients have the right to participate in ongoing studies and potentially benefit from novel therapies..."