Thread by @laxswamy

Now hearing from @sameepsehgal9 on VTE in #COVID19

Wide variation in incidence of VTE in COVID-ICU patients. Meta-analysis in middle -- about 30% #CHEST2020

'at least in sick ICU patients, the incidence of thrombosis in #COVID19 is probably higher than other diseases like influenza' @sameepsehgal9 #chest2020

Who clots and who doesn't with #COVID19? @sameepsehgal9 synthesizes the literature. Not too surprising overall. #chest2020

Nice perspective from @sameepseh - some people clot early, some clot late, and in some the clot is the reason for presentation. Mild/delayed is scary, but seems to be very rare. #CHEST2020

I like this approach: 'if something doesn't make sense, look for VTE because the incidence is higher'

but otherwise hard to predict. #CHEST2020

and now, the man, the myth, the legend... @ParijatSen11!! Pathology of thrombosis in #COVID19 - first off, Non-COVID ARDS also clots... #CHEST2020

the title of this slide is 100% why i am here, @ParijatSen11

but also - interesting atypical features here- myocardial venous thrombosis causing MI! #chest2020

whoaa- the ABO linkage is super interesting! Here are the takeaways, check out the full talk if you can #chest2020
#COVID19 thrombosis

Now @shruti_gadre on what to do about #COVID19 thrombosis. First, routine screening hasn't been shown to be that effective. Dr. Gadre suggests we maintain a high index of suspicion and pay special attention to intravascular catheters. #CHEST2020

Most COVID patients would be eligible for one of the 3 landmark trials for thromboprophylaxis, supporting pharmacologic prophylaxis. Favor LMWH (caution re renal injury), avoid DOAC. @shruti_gadre #chest2020

Beware full dose anticoag for all comers- studies like these that showed a benefit had differences in the two groups (ex: intervention arm was more likely to be on MV) #chest2020

These are important considerations that make #COVID19 patients different from other ICU patients. #CHEST2020

Use standard approach to advanced therapeutics. in other words, we will continue to argue non-stop about yellow and orange 🥴 #chest2020

Conclusions - no routine surveillance screening for VTE in #COVID19, standard ppx for everyone in ICU, lots of data in the pipeline! #CHEST2020