cord-000716-fhm8abxp	2012	BACKGROUND: In the present study, the whole human genome oligo microarray was employed to investigate the gene expression profile in symptomatic pulmonary embolism (PE). Gene Ontology analysis showed the genes with down-regulated expressions mainly explain the compromised T cell immunity. However, mRNA expression of P-selectin (mainly distributed on the surface of ECs and platelets) and E-selection (mainly distributed on the surface of activated ECs) are not elevated in PE group which indicate venous endothelial cells are not impaired in patients with PE (Fig.2) . Gene ontology analysis exhibited compromised T cell mediated immune function, and t test indicated associated genes were significantly down-regulated in patients with PE than in control groups. Two genes with down-regulated expressions are closely related to the T cell mediated immunity according to GO analysis (with high value of Enrichment). Patient outcomes after deep vein thrombosis and pulmonary embolism: the Worcester Venous Thromboembolism Study
cord-000728-ligqoj24	2012	The characteristics of human genomics and cellular immune function between clinically symptomatic venous thromboembolism (VTE) and controls were systematically compared to explore the immunologic pathogenesis of VTE. In addition, in 2010, we detected virus-like microorganisms in the lymphocytes of a young pulmonary hypertension patient with increased D-Dimer, which morphologically confirmed the attack of T cells by virus, and peripheral decreased CD3 + and CD8 + level also indicated virus infection caused significantly compromised function of T cells (10) . In addition, flow cytometry was performed to investigate the changes in immune cells in VTE patients, which aimed to validate the results from genome analysis. The Go analysis of the genomic study targeted the decreased immune function of T cells and immune receptor complex in PE patients, suggesting the occurrence of PE is closely related to the immune dysfunction.
cord-006870-f5w6fw6q	2017	Subjective perceptions of recovery were assessed via responses to the forced-choice dichotomized question, "Do you feel that you have made a complete recovery from the arrest?"Objective outcome measures of recovery included: Repeatable Battery for Neuropsychological Status (RBANS), Modified Lawton Physical Self-Maintenance Scale (L-ADL), Barthel Index (BI), Cerebral Performance Category Scale (CPC), Center for Epidemiological Studies-Depression scale (CES-D), and Post traumatic stress disorder-checklist (PTSD-C). Utilizing data from the Citicoline Brain Injury Treatment (COBRIT) trial, a prospective multicenter study, we identified 224 patients who met the inclusion criteria; 1) placement of an ICP monitoring device, 2) Glasgow coma score (GCS) less than 9, 3) EVD placement prior to arrival or within 6 hours of arrival at the study institution. The objective of this study was to examine the incidence rates of pre-specified medical and neurological ICU complications, and their impact on post-traumatic in-hospital mortality and 12month functional outcomes.
cord-009997-oecpqf1j	2018	Completed cranial radiation and proceeded to allogeneic stem cell transplant with unrelated cord marrow donor and is disease free at approximately day +200.Case 2: 5 year-old female diagnosed with FLT3 and MLL negative AML and completed treatment per COG AAML1031 study on the low risk arm without Bortezomib. Design/Method: This study was a retrospective chart review that included patients 3 to 23 years old with sickle cell disease type SS and S 0 followed at St. Christopher''s Hospital for Children. Background: Hydroxyurea, chronic blood transfusion, and bone marrow transplantation can reduce complications, and improve survival in sickle cell disease (SCD), but are associated with a significant decisional dilemma because of the inherent risk-benefit tradeoffs, and the lack of comparative studies. Brown University -Hasbro Children''s Hospital, Providence, Rhode Island, United States Background: Despite clinical advances in the treatment of sickle cell disease (SCD) in pediatric and young adult patients, pain remains a significant source of disease-related morbidity.
cord-257939-tgpsd3r7	2020	title: A 46-Year-Old Woman Who Presented with Diabetic Ketoacidosis and COVID-19 Pneumonia with Multiple Pulmonary Thromboemboli: A Case Report Patient: Female, 46-year-old Final Diagnosis: COVID provoked thromboembolism Symptoms: Cough • dyspnea Medication:— Clinical Procedure: — Specialty: Infectious Diseases • General and Internal Medicine OBJECTIVE: Unknown ethiology BACKGROUND: Coronavirus disease 2019 (COVID-19) occurs because of a novel enveloped ribonucleic acid coronavirus called severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2). Here we describe a case of COVID-19 provoked pulmonary embolism in a young patient already receiving prophylactic treatment for VTE. CONCLUSIONS: The finding of the case suggested that low-molecular-weight heparin prophylaxis may not be sufficient to prevent VTE in COVID-19 pneumonia. Here, we describe a case of COVID-19 that provoked PE in a young patient already receiving prophylactic treatment of venous thromboembolism (VTE). The findings of the case suggested that low-molecular-weight heparin prophylaxis may not be sufficient to prevent VTE in COVID-19 patients with proinflammatory state.
cord-261629-ylajz928	2020	title: Reducing the Risk of Venous Thrombosis During Self-Isolation and COVID-19 Pandemic for Patients With Cancer: Focus on Home Exercises Prescription Recent studies have demonstrated that active ankle dorsiflexion, plantar flexion, subtalar inversion, and eversion exercises increase venous return in the lower extremity, which suggest that combination of these exercises will be effective to reduce and even prevent the stasis and so forth, VTE. 4 According to the American Society of Hematology 2019 guidelines for management of VTE, it is appropriate to use compression stocks in acutely or critically ill patients, who are not appropriate for anticoagulant prophylaxis because of bleeding risk. In conclusion, we recommend all caregivers to include a reasonable yet effective prescription of home exercise for all patients with malignancies. Ufuk Demirci https://orcid.org/0000-0001-6923-1470 Elif G. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update
cord-262125-0vajpo98	2020	title: Updated hospital associated venous thromboembolism outcomes with 90-days follow-up after hospitalisation for severe COVID-19 in two UK critical care units Hospitalisation with COVID-19 infection has been associated with an increased incidence of thrombosis, particularly in the critical care setting. Our two centres have previously described the early in-patient incidence of venous thromboembolism (VTE) at the peak of the COVID-19 outbreak in the United Kingdom1,2. The risk of hospital-associated VTE (HAT) for patients has been shown to extend from admission to 90 days following discharge with an early peak within the first weeks of this period3. We conducted an observational study of our previous cohorts with a minimum of 90 days follow-up from their critical care admission at our centres. The estimated cumulative incidence of VTE over a minimum of 90 days following critical care admission was 18.6% shown in Figure 1 (a) (95% confidence interval 12.4-25.8). Post-discharge venous thromboembolism following hospital admission with COVID-19
cord-274542-fpzk5k79	2020	UFH should be limited to patients with CrCl < 30 mL/min An invasive "catheter"-based therapy for PE is indicated in selected cases with contraindication to anticoagulant drugs, recurrent events despite adequate anticoagulation, or when systemic fibrinolysis cannot be performed For the risk stratification of patients with VTE, monitoring of the following parameters is useful: troponin, BNP, D-dimer, blood cell count, fibrinogen, prothrombin time, activated partial thromboplastin time, and degradation products of fibrin After the initial approach, DOACs may represent an option for in-hospital treatment of a VTE episode in patients with clinical stability and decreasing inflammation After a VTE episode, DOACs should represent the therapy of choice at discharge The use of imaging techniques in diagnosing a VTE episode is complex, because of the risk of viral transmission to other patients and to healthcare workers, and must be regulated by specific in-hospital protocols aimed at limiting such risk.
cord-277146-4a4vz36h	2020	Multiple reports have reported the presence of deranged parameters of coagulation in patients of In this review, we will discuss the various pathophysiological mechanisms leading to COVID-19 associated coagulopathy (CAC), derangement in laboratory parameters, incidence, and risk factors of venous thromboembolism (VTE) and prevention and treatment of CAC. Pulmonary Intravascular Coagulation, its Histopathological Evidence and Contribution of Cytokine Storm COVID-19 patients have been shown to have high levels of D-dimer [8, 9] but unlike patients of sepsis, they only have a mild prolongation of prothrombin time (PT), activated partial thromboplastin time (APTT), mild thrombocytopenia [4, 9] . They recommend standard dose LMWH as most preferred agent followed by UFH then DOAC for acutely ill and critical hospitalized patients with COVID-19. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy
cord-277201-jzjxsetx	2020	We suspect that a prothrombotic inflammatory response provoked by coronavirus disease could be the culprit, acting as an additive effect on middle-aged patients with known risk factors for venous thromboembolism. In addition to coagulation factor abnormalities, other reported findings of increased D-dimers, ferritin, and lactate dehydrogenase further support the assertion that a prothrombotic response to the virus is driving the thromboembolic events among COVID-19 patients [9] . Severe COVID-19 infections have also been associated with an inflammatory prothrombotic state, also potentially playing a key role behind the increase in reported thromboembolic complications. We suspect that the existing risk factors present along with the superimposed prothrombotic state induced by COVID-19 induced inflammatory response may have precipitated the development of the venous thromboembolism resulting in PE. e CHEST Guideline and Expert Panel Report on management of venous thromboembolism (VTE) in COVID-19 patients outlines various recommendations for management of acute VTE.
cord-282636-u0ea02fc	2020	For three patients, we were able to test sera for neutrophil extracellular trap (NET) remnants and found significantly elevated levels of cell-free DNA, myeloperoxidase-DNA complexes, and citrullinated histone H3. Given strong links between hyperactive neutrophils, NET release, and thrombosis in many inflammatory diseases, the potential relationship between NETs and VTE should be further investigated in COVID-19. Neutrophil-derived neutrophil extracellular traps (NETs) play a pathogenic role in many thrombo-inflammatory states including sepsis 4, 5 , thrombosis [6] [7] [8] , and respiratory failure 9, 10 . We identified four patients admitted to a large academic medical center with COVID-19 who also developed VTE (either deep vein thrombosis or pulmonary embolism) despite immediate initiation of prophylactic-dose heparin. 30.20086736 doi: medRxiv preprint elevated by the time the patient was diagnosed with deep vein thrombosis on day 20 ( Table 2) . Vivo Role of Neutrophil Extracellular Traps in Antiphospholipid Antibody-Mediated Venous Thrombosis
cord-283267-72wrzw09	2020	The recognition of the coagulopathy with COVID-19, and the early evidence that suggests that thrombosis in these patients is higher than that seen in similarly ill hospitalized patients with other respiratory infections has led to the urgent need for practical guidance regarding prevention, diagnosis, and treatment of VTE. 19 Pooled risk estimates for benefits and harms of anticoagulant thromboprophylaxis in critically ill medical patients without COVID-19 differ across meta-analyses, 19, 22, 46 but practice guidelines consistently recommend anticoagulant thromboprophylaxis with LMWH (or unfractionated heparin [UFH]) over no such therapy. Our literature search did not identify any randomized trials assessing the efficacy and safety of anticoagulants for the treatment of acute VTE in hospitalized or critically ill COVID-19 patients. Our literature search did not identify any randomized trials or prospective cohort studies assessing the efficacy or safety of any thrombolytic therapies for the management of critically ill patients with COVID-19 without objective evidence of VTE and VTE-associated hypotension.
cord-288626-7bp92xyo	2020	OBJECTIVES: The purpose of this study was to evaluate whether extended-duration rivaroxaban reduces the risk of venous and arterial fatal and major thromboembolic events without significantly increasing major bleeding in acutely ill medical patients after discharge. The lower 7.5 mg dose of rivaroxaban used in patients with moderate renal insufficiency was found to be ineffective (8) A meta-analysis of arterial thrombosis (including MI and ischemic stroke) of older studies involving w11,000 medically ill inpatients receiving heparinbased prophylaxis did not find a reduction of these events compared with control subjects (odds ratio: On-treatment includes all data from randomization to 2 days after the last dose of the study drug (inclusive). Our analysis suggests that in at-risk medically ill patients who are discharged from the hospital, extended-duration rivaroxaban at the 10 mg daily dose leads to a significant risk reduction in a composite of fatal and major thromboembolic eventsincluding symptomatic VTE, MI, nonhemorrhagic stroke, and CV death-without a significant increase in major bleeding, compared with placebo.
cord-291483-ni6toh8c	2020	One of the most important known complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the occurrence of venous thromboembolic (VTE) events, especially in critically ill patients and hospitalized in the intensive care unit. Diagnosis of VTE disease, especially pulmonary embolism, in patients with SARS-CoV 2 infections are incredibly difficult and challenging. As the first para-clinical approach in the diagnostic algorithm of pulmonary embolism, the use of D-dimer in the patients admitted with SARS-CoV 2 infection is controversial, because this marker has been increased as an acute reaction factor in hospitalized patients in need of respiratory care and loses its predictive value due to its low specificity (28) . Finally, according to recent studies, it is recommended that most of the hospitalized COVID-19 patients, especially critically ill patients admitted to ICU or cases with high D-dimer level, use pharmacological VTE prophylaxis (23, 37) .
cord-296607-h2zwlyz7	2020	What is clear is that patients appear to be at higher risk for thrombotic disease states including acute coronary syndrome (ACS), venous thromboembolism (VTE) such as deep vein thrombosis (DVT) or pulmonary embolism (PE), or stroke. In most scenarios, direct oral anticoagulants (dabigatran, rivaroxaban, apixaban, and edoxaban) are recommended over warfarin due to large randomized controlled trials showing noninferiority or superiority for stroke reduction and superiority for bleeding risk in patients with non-valvular atrial fibrillation [29] [30] [31] [32] . The use of UFH or LMWH may be considered in patients with high potential stroke risk and new onset atrial fibrillation; however, heparin drips require constant monitoring and titration of dosing during hospitalization leading to increased nursing exposure to potential COVID-19 patients. A French cohort of ICU patients on pharmacologic prophylaxis found a high prevalence of thrombotic complications including PE, stroke, circuit clotting of continuous renal replacement therapy or extracorporeal membrane oxygenation (ECMO) with minimal bleeding risk suggesting the need for higher doses of prophylactic anticoagulation in this patient population [70] .
cord-297001-4g3wb8qi	2020	Understanding the true impact of VTE on patients with COVID-19 will potentially improve our ability to reach a timely diagnosis and initiate proper treatment, mitigating the risk for this susceptible population during a complicated disease. However, many of the COVID-19 patients may present with high levels of D-dimer due to other causes -inflammation, disseminated intravascular coagulation, advanced age, or infection [23] suggesting the need for CTPA as an initial rule-out test as well. Finally, based on the correlation between high levels of D-dimer and severe COVID-19 disease [7, 37] as well as higher mortality rate [5, 38] , the International Society on Thrombosis and Haemosthasis (ISTH) and American Society of Hematology (ASH) guidelines [39] advises prophylactic LMWH in all hospitalized COVID-19 patients in the absence of any contraindications (active bleeding and platelet count less than 25 × 10 9 /L) [34, 40] .
cord-301493-32l52q3s	2020	From this cohort, patients with confirmed VTE (either during or after their hospital encounter) were identified by administrative query of the EHR.: Between 1 March 2020 and 1 May 2020, 6153 patients with COVID-19 were identified; 2748 of these patients were admitted, while 3405 received care exclusively through the emergency department. 7 To provide additional information about the association of VTE with COVID-19, we present a large retrospective cohort study examining all polymerase chain reaction-confirmed COVID-19 patients admitted to hospitals or treated in emergency departments affiliated with the Ochsner Health System. To estimate the rate of failure of VTE prophylaxis among COVID-19-positive hospitalized patients, we defined failure as any DVT or PE event diagnosed $3 days after the admission of a patient who had received $2 days of evidence-based mechanical or pharmacologic VTE prophylaxis immediately prior.
cord-306997-84pjfawk	2020	A number of pathogenic mechanisms have been hypothesized for VTE in COVID-19 patients, including active inflammation, immobilization and intensive care treatments, but the limited evidence available in the literature does not allow to estimate the relative contribution of each of the abovementioned factors [8] . Starting from these premises, we here aimed to define VTE rates and types, not considering peripheral and central catheter-related thrombosis, among a cohort of COVID-19 patients during their hospital stay at the San Matteo Hospital Foundation (Pavia, Northern Italy). We extracted data from medical records of all 259 consecutive patients with a diagnosis of COVID-19 admitted to the Departments of Internal Medicine, Infectious Disease, Intensive Care, and Respiratory Disease of the San Matteo Hospital Foundation (Pavia, Northern Italy), between March 19th and April 6th, 2020. We reviewed records of all 259 COVID-19 patients for demographic information, co-morbidities, risk factors for VTE according to the Padua prediction score [16] , laboratory tests and anticoagulation treatment at the time of hospital admission.
cord-311622-fqptz6v3	2020	We read with interest the study published by Tang and coll.(1) in a recent issue of the Journal of Thrombosis and Haemostasis. The definition of severe COVID‐19 was the presence of at least one of following: respiratory rate ≥30 breaths /min; arterial oxygen saturation ≤93% at rest; PaO2/FiO2 ≤300 mmHg. The Authors of this study also reported that, among subjects not treated with heparin, mortality raised according with D‐dimer levels. In this retrospective analysis, conducted at the Tongji Hospital of Wuhan, China, it is reported that heparin treatment reduces mortality in subjects affected by severe COVID-19 who have "sepsis-induced coagulopathy". The definition of severe COVID-19 was the presence of at least one of following: respiratory rate ≥30 breaths /min; arterial oxygen saturation ≤93% at rest; PaO2/FiO2 ≤300 mmHg. The Authors of this study also reported that, among subjects not treated with heparin, mortality raised according with D-dimer levels.
cord-312388-pc89ybxw	2020	ACE-2 angiotensin-converting enzyme 2, C4d complement 4d, C5b-9 complement 5b-9, COVID-19 coronavirus disease 2019, IL interleukin, K clot formation time, LY30 clot lysis at 30 min, MA maximum amplitude, MAC membrane attack complex, MASP2 mannose-binding proteinassociated serine protease 2, R reaction time, SARS-CoV-2 severe acute respiratory syndrome coronavirus 2, TEG thromboelastography, vWF von Willebrand factor showed small and firm thrombi in peripheral parenchyma [5] . Routine laboratory testing was performed in 24 critically ill COVID-19 patients and identified several abnormalities, including normal or slightly prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), normal or increased platelet count, and increased D-dimer and fibrinogen levels [12] . In a series of 184 patients (all patients receiving prophylactic anticoagulation) with severe COVID-19 and in the ICU, VTE was reported in 27% [16] ; the study was associated with a 13% mortality rate.
cord-313243-pwmi765q	2020	OBJECTIVES: To investigate the incidence of objectively confirmed venous thromboembolism (VTE) in hospitalized patients with COVID‐19. CONCLUSIONS: The observed risk for VTE in COVID‐19 is high, particularly in ICU patients, which should lead to a high level of clinical suspicion and low threshold for diagnostic imaging for DVT or PE. 1, 2 Additionally, more pronounced coagulation activation seems to be correlated with a severe disease course, including admission to the intensive care unit (ICU) and death. In a cohort of 81 ICU patients in China, in which routine thromboprophylaxis was not the standard of care, the proportion of patients who were diagnosed with DVT was 25%; a follow-up duration or cumulative incidence was not reported. The 3% risk of VTE among patients who were not admitted to ICU is considerable, despite the standard use of thrombosis prophylaxis. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: an updated analysis Incidence of venous thromboembolism in hospitalized patients with COVID-19
cord-314259-26jriik0	2020	The prevalence of deep vein thrombosis (DVT) in patients hospitalized for SARS-CoV-2 infection remains, however, not well defined, especially for those admitted to COVID-19 Standard Care Units (SCU). Therefore, we designed a study with the aims of assessing the prevalence of DVT among subjects with SARS-CoV-2 pneumonia in the setting of SCU and investigating the clinical and laboratory characteristics associated with DVT in COVID-19 patients. The findings of a high prevalence of DVT in patients taking the usual thromboprophylaxis and estimated at low risk of thrombotic complications according to the traditional risk assessment model (such as the Padua Prediction Score), emphasize some unsolved issues: i) potential SARS-CoV-2-related hypercoagulable state, ii) appropriate VTE risk stratification for hospitalized COVID-19 patients, and iii) the choice of anticoagulant agents and relative doses, which require further investigations [2] .
cord-320822-etibcspx	2020	CONCLUSIONS: Fibrinolysis shutdown, as evidenced by elevated D-Dimer and complete failure of clot lysis at 30 minutes on thromboelastography, predicts thromboembolic events and need for hemodialysis in critically ill patients with COVID-19. While not significant, thrombotic stroke rate was also increased from 7% to 30% (p=0.274 In the trauma population, hypercoagulable TEG parameters predict venous thromboembolism (VTE) 2.4 -6.7 fold higher based on higher maximum amplitude (MA) parameters despite appropriate prophylactic anticoagulation [16] [17] [18] [19] . Elevated D-dimer levels were also associated with potential micro-thrombotic disease leading to Recently, acute fibrinolysis shutdown has been demonstrated in early sepsis and found to correlate to increased morbidity and mortality 32 . A TEG LY30 of 0% and a D-dimer of greater than 2600 ng/ml together suggest complete fibrinolysis shutdown and markedly elevated risk of renal failure, VTE, and thrombotic events.
cord-324245-cfiekxr4	2020	In a single-center cross-sectional study, all patients hospitalized for more than 5 days in Internal Medicine Department with confirmed COVID-19 pneumonia received 2-point compressive ultrasound assessment (CUS) of the leg vein system during a single day. Aim of our study was to evaluate the prevalence of deep vein thrombosis of the legs in a cohort of patients admitted to Internal Medicine of Cremona Hospital, with severe SARS-Cov-2 infection and treated with standard thromboprophylaxis, in a period between 5 and 10 days from hospitalization. The main demographic and clinical characteristics of the patients with DVT are shown in Table 2 Discussion Our study shows that in patients admitted to a hospital medical ward because of COVID-19-associated pneumonia, the prevalence of silent proximal DVT was as high as 13.6%, despite standard anticoagulant prophylaxis.
cord-324265-j3v3i8vm	2020	The severity of the derangement of coagulation parameters in COVID-19 patients has been associated with a poor prognosis, and the use of low molecular weight heparin (LMWH) at doses registered for prevention of venous thromboembolism (VTE) has been endorsed by the World Health Organization and by Several Scientific societies. In these patients, low molecular weight heparin (LMWH) or unfractionated heparin (UFH) at doses registered for prevention of venous thromboembolism (VTE) seemed to be associated with a lower risk of death [10] and is currently recommended by the World Health Organization [11] and by several scientific societies [12] [13] [14] [15] [16] [17] [18] (Table 1) .
cord-326272-ya3r0h1t	2020	30 Other trials have evaluated VTE rates in CUS screened ICU patients with COVID-19 receiving pharmacologic prophylaxis with rates as high as 69% to 85%, which are higher than reported in typical ICU patients (Table 3) . Most hospitalized patients with COVID-19 are over age 40 years and have a number of risk factors for VTE, such as pneumonia, obesity, immobility, respiratory disease, elevated D-dimer levels, as well as potentially underlying heart failure, smoking, varicose veins, cancer, and previous VTE. 82 An observational cohort study of critically ill patients with severe ARDS from H1N1 viral pneumonia demonstrated that empiric systemic heparinization titrated to a goal heparin level of 0.3 -0.7 anti-Xa units/mL was significantly better at reducing VTE rates than standard prophylactic doses of either UFH or LMWH. 32 As discussed previously, a number of observational studies have reported higher than expected rates of VTE in critically ill patients with COVID-19, despite the use of standard dose anticoagulant prophylaxis.
cord-327370-zo0n8wf6	2020	We present the case of a patient with an initial presentation of COVID-19 pneumonitis requiring mechanical ventilation for nearly 2 weeks and total admission time of 3 weeks. 1 This case examines aspects of COVID-19 emphasising the increased thrombogenicity seen during infection and the potential need for extended anticoagulation following recovery particularly in those patients with severe illness and pre-existing risk factors. 18 Initial data suggest that patients with complicated COVID-19 infection have nearly three times the concentration of IL-6 compared with those exhibiting less severe disease. 24 The International Society for Thrombosis and Haemostasis suggests that prophylactic treatment with LMWH is prudent in all patients with COVID-19, particularly with severe disease or Findings that shed new light on the possible pathogenesis of a disease or an adverse effect extreme derangements in clotting parameters. 2 Compared with other populations, patients with COVID-19 appear to have higher incidences of VTE particularly with deranged clotting markers, critical care admission or reduced mobility.
cord-328220-toeq4xq0	2020	Areas of management requiring clinical equipoise include agent selection and dosing, continuation vs interruption of home oral anticoagulant therapy during hospital admission, and postdischarge VTE prophylaxis. CONCLUSION: Practical guidance on anticoagulation considerations and dosing suggestions are provided to assist clinicians faced with challenging anticoagulation-related situations in caring for hospitalized COVID patients until formal evidence-based guidelines become available. [8] [9] [10] [11] [12] Areas of current clinical uncertainty include dose and agent of choice, continuation vs interruption of home oral anticoagulant therapy while admitted, and postdischarge VTE prophylaxis. Upon review of the available evidence, we believe that clinicians may wish to consider a 3-tiered approach to stratifying anticoagulation intensity ( Figure 1 ), with consideration of the aforementioned factors to guide and assist in decision making. A patient may be categorized into tier II based on acuity and/or VTE risk factors (eg, a patient who is on a general medical floor but clinically deteriorating, with an upward trend in inflammatory marker and/or D-dimer levels).
cord-335020-at43c8q7	2020	In this article, we discuss the many doubts currently existing on the use of heparins and the correct prevention and diagnosis of VTE in COVID-19 patients, with physicians that juggle between pragmatic choices, different suggestions being released on a daily by hospital and medical societies, and the lack of solid evidence or guidelines. To support this concept, it is worth mentioning the report published by Danzi and coll., which describes the case of a 75-year-old woman who was hospitalized in Cremona, Italy, after 10 days of fever and a recent onset of dyspnea at home and was diagnosed with severe COVID-19-positive bilateral pneumonia and concomitant acute PE two days after hospital admission [19] . This issue is critical and has been taken into consideration in a recent position paper from the Italian Society on Thrombosis and Haemostasis (SISET), in which it is suggested to maintain thromboprophylaxis at home for 7-14 days after hospital discharge or in the pre-hospital phase, at least in subjects with pre-existing or persisting VTE risk factors [16] .
cord-336000-v88bq4bx	2020	OBJECTIVES: The OVID study will demonstrate whether prophylactic-dose enoxaparin improves survival and reduces hospitalizations in symptomatic ambulatory patients aged 50 or older diagnosed with COVID-19, a novel viral disease characterized by severe systemic, pulmonary, and vessel inflammation and coagulation activation. The OVID study will show whether prophylactic-dose enoxaparin improves survival and reduces any hospitalizations in ambulatory patients aged 50 or older diagnosed with COVID-19, a novel viral disease characterized by severe systemic, pulmonary, and vessel inflammation and coagulation activation. <30% of the expected number of patients six months after the enrolment of the first patient, also based on the course of SARS-CoV2 infections in Switzerland;  when the safety of the participants is doubtful or at risk, respectively, based on recommendations received from DSMB committee;  changes in accepted clinical practice that make the continuation of a clinical trial unwise, including the results of similar studies or the publication of international guidances.
cord-339695-3ij5pjjy	2020	[1] [2] [3] Early studies already reported on coagulation abnormalities and coagulopathy with a rather prothrombotic phenotype in patients with 5] With the better understanding of COVID-19 and its clinical course, venous thromboembolism (VTE), a disease entity covering pulmonary embolism (PE) and deep vein thrombosis (DVT), has been recognized as a particular complication of the disease. These included methodological specifics of the studies (study design, health care setting), clinical information of the study population (demographics, comorbidities, disease severity, use of pharmacological thromboprophylaxis, ultrasound screening, and D-dimer levels), and outcome specifics (definition, type, and rate of VTE). After excluding studies with a high risk of underlying bias, quantitative results from 66 studies were aggregated within a meta-analysis, including 28,173 patients (1, Figure 2 shows a Forrest plot of VTE rates, together with information on health care setting, the performance of screening and outcome definition of respective studies.
cord-342603-k0f33p3l	2020	Hospitalized acutely-ill medical patients, including those with infections such as viral pneumonia, are at increased risk for VTE, and antithrombotic practice guidelines recommend thromboprophylaxis with twice-or thrice-daily subcutaneous unfractionated heparin (UFH) oncedaily subcutaneous low-molecular-weight heparin (LMWH), or fondaparinux to reduce this risk, although fondaparinux is infrequently used due to its long half-life and reversibility concerns [11, 12] . All rights reserved the absence of COVID-19-specific data, it is reasonable to consider extended-duration thromboprophylaxis with LMWH or a DOAC for at least 2 weeks and up to 6 weeks post-hospital discharge in selected COVID-19 patients who are at low risk for bleeding and with key VTE risk factors such as advanced age, stay in the ICU, cancer, a prior history of VTE, thrombophilia, severe immobility, an elevated D-dimer (>2 times ULN), and an IMPROVE VTE score of 4 or more.
cord-346135-uidvtpjw	2020	We found greatest consensus on recommendations for heparin-based pharmacologic venous thromboembolism (VTE) prophylaxis in COVID-19 patients without contraindications. We found greatest consensus on recommendations for heparin-based pharmacologic venous thromboembolism (VTE) prophylaxis in COVID-19 patients without contraindications. Protocols differed regarding incorporation of D-dimer tests, dosing of VTE prophylaxis, indications for post-discharge pharmacologic VTE prophylaxis, how to evaluate for VTE, and the use of empiric therapeutic anticoagulation. Among the protocols that J o u r n a l P r e -p r o o f Journal Pre-proof addressed a clinical question, we then reported the proportion of institutions that supported a specific practice ("consensus"). Although there was near-universal agreement on the need for heparin-based VTE prophylaxis for COVID-19 inpatients without contraindications, recommended dosing strategies varied across institutions (Figure 1a) . In contrast, four protocols (19%) specifically recommended against empiric therapeutic dosing of anticoagulation based on lab values in the absence of other clinical indications such as proven VTE.
cord-351101-l8b2cv4z	2020	SUMMARY: Here we report development of a pulmonary embolism (PE) in a young patient without other VTE risk factors who was treated for COVID-19 in an emergency department (ED) and discharged home without VTE prophylaxis, which was consistent with current recommendations. 2, [5] [6] [7] In this article we report a case of pulmonary embolism (PE) in an ambulatory patient that developed 2 weeks after discharge from an emergency department (ED) following diagnosis of COVID-19 and treatment without DVT prophylaxis. Results were normal except for a slightly low serum sodium concentration (133 mEq/L), chloride Development of pulmonary embolism in a nonhospitalized patient with COVID-19 who did not receive venous thromboembolism prophylaxis concentration (96 mmol/L), and absolute lymphocyte count (12,000/µL). [15] [16] [17] The results from these studies do not support the routine use of extended postdischarge thromboprophylaxis, and current guidelines do not recommend extended-duration outpatient VTE prophylaxis in acutely ill hospitalized medical patients, critically ill medical patients, or medical outpatients with minor risk factors for VTE, such as infection.
cord-352793-50ym7h4t	2020	Severe novel coronavirus pneumonia (NCP) patients have abnormal blood coagulation function, but their venous thromboembolism (VTE) prevalence is still rarely mentioned. METHODS: In this study, 81 severe NCP patients in the intensive care unit (ICU) of Union Hospital (Wuhan, China) were enrolled. A number of studies have shown that coagulation dysfunction exists in patients with severe novel coronavirus pneumonia (NCP), [1] [2] [3] [4] which is clearly correlated with poor prognosis. Table 3 shows the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of different D-dimer levels in predicting VTE in patients with severe NCP. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia
cord-353692-2zotqreu	2020	title: Effect on Thromboprophylaxis among Hospitalized Patients Using a System-wide Multifaceted Quality Improvement Intervention: Rationale and Design for a Multicenter Cluster Randomized Clinical Trial in China Methods To facilitate implementation of guideline recommendations, we conduct a multicenter, adjudicator-blinded, cluster-randomized clinical trial, aiming to assess the effectiveness of a system-wide multifaceted quality improvement (QI) strategy on VTE prophylaxis improvement and thromboembolism reduction in clinical setting. In intervention group, hospitals receive the concept of appropriate in-hospital thromboprophylaxis plus a multifaceted QI which encompasses four components: (1) an electronic alert combining computer-based clinical decision support system and electronic reminders, (2) appropriate prophylaxis based on dynamic VTE and bleeding risk assessments, (3) periodical audit and interactive feedback on performance, (4) strengthened training and patient education. To better understand usual care in control group in this study, we will conduct a baseline survey in recruited hospitals before cluster randomization, collecting information on VTE and bleeding risk assessment, prophylactic approaches, initiating time for prophylaxis, etc.