Gillespie Laura, Khan Rashid Z, Stillson John E, Bunch Connor M, Shariff Faisal Salim, Speybroeck Jacob, Grisoli Anne, Schmidt Meredith Wierman, Phyu Htay, Jablonski Jason, Wells Byars, Fulkerson Daniel H, Oancea Lyndsay, Leiser Abraham, Walsh Mark
Department of Quality and Performance Improvement, Saint Joseph Regional Medical Center, Mishawaka, IN, USA.
Department of Hematology, Michiana Hematology Oncology, Mishawaka, IN, USA.
J Pharm Health Care Sci. 2021 Apr 1;7(1):19. doi: 10.1186/s40780-021-00201-2.
The recognition, prevention and treatment of venous thromboembolism (VTE) remains a major challenge in the face of the recent COVID-19 pandemic which has been associated with significant cardiovascular, renal, respiratory and hematologic complications related to hypercoagulability. There has been little literature thus far on the utility of screening ultrasound and the role of the clinical pharmacist in treating these patients.
We present a prospective pilot program of thirty-one consecutive COVID-19 patients who were provided four extremity screening ultrasounds for VTE on admission. This was coordinated by a clinical pharmacist as part of a multidisciplinary approach. Quantitative and qualitative data were recorded with the goal of describing the utility of the clinical pharmacist in ultrasound screening. Data collected include demographics, information on clinical symptoms or signs at presentation, and laboratory and radiologic results during the hospitalization from each individual electronic medical record.
Nine of the thirty-one patients presented with VTE. Of the nine patients, there were twenty-two total clotted vessels, all of which were asymptomatic. The clinical pharmacist, as the coordinator for a multidisciplinary COVID-19 associated coagulopathy management team, drafted a screening and treatment protocol for anticoagulation prophylaxis and therapy of VTE after ultrasound findings.
VTE screening of hospitalized COVID-19 patients reveals a significant number of asymptomatic VTEs and justifies diagnostic, prophylactic, and treatment measures coordinated by a clinical pharmacist.
面对近期与高凝状态相关的重大心血管、肾脏、呼吸和血液学并发症的新型冠状病毒肺炎大流行，静脉血栓栓塞症（VTE）的识别、预防和治疗仍然是一项重大挑战。迄今为止，关于筛查超声的效用以及临床药师在治疗这些患者中的作用的文献很少。
我们提出了一项前瞻性试点计划，对31例连续的新型冠状病毒肺炎患者入院时进行四肢VTE筛查超声检查。这由一名临床药师作为多学科方法的一部分进行协调。记录定量和定性数据，目的是描述临床药师在超声筛查中的效用。收集的数据包括人口统计学信息、就诊时的临床症状或体征信息，以及每位患者电子病历中住院期间的实验室和影像学结果。
31例患者中有9例出现VTE。在这9例患者中，共有22条血管出现血栓形成，所有这些都是无症状的。临床药师作为多学科新型冠状病毒肺炎相关凝血病管理团队的协调员，根据超声检查结果起草了VTE抗凝预防和治疗的筛查及治疗方案。
对住院的新型冠状病毒肺炎患者进行VTE筛查发现大量无症状VTE，证明由临床药师协调的诊断、预防和治疗措施是合理的。
