Implementation of a closed-loop medication reconciliation process for ambulatory oncology patients at Winchester District Memorial Hospital.

Medication Reconciliation (MedRec) is a proven method of optimizing pharmacotherapy and decreasing incidence of Adverse Drug Events (ADEs); however, consistent and correct execution is often a challenge in the setting of outpatient oncology. Ambulatory chemotherapy patients are particularly susceptible to polypharmacy and ADEs and their medication management is often complicated due to gaps in communication between an increased volume of non-co-located, multidisciplinary, healthcare providers. Acknowledging these challenges, Winchester District Memorial Hospital (WDMH) led an initiative to create an ambulatory chemotherapy MedRec process using behavioural change approaches. Prior to the intervention, ambulatory chemotherapy MedRec at WDMH was conducted informally via an "open-loop" process. Through an iterative quality improvement process which involved understanding and communicating failure points in the transmission of patients' medication information directly with the frontline medical staff, a practical and sustainable "closed-loop" system evolved, which improved rates to 97.8% overall completion post-intervention.

Strategies to conserve salbutamol pressurized metered-dose inhaler stock levels amid COVID-19 drug shortage.

Essential inhaler medications for patients with respiratory diseases are backordered due to the coronavirus disease of 2019 (COVID-19). In hospitals, there has been a drastic increase in the use of salbutamol pressurized metered-dose inhalers (pMDIs), as well as salbutamol Diskus, leading to a decline in availability and causing interruptions in the supply chain. Patients with asthma are at higher risk of respiratory complications if they are infected with COVID-19. Salbutamol, a short-acting ß-agonist (SABA), could be a life-saving medication during critical conditions. Other short-acting muscarinic antagonists (SAMAs), such as ipratropium pMDI, and combinations of SABA/SAMA, such as Combivent Respimat, are also starting to have supply issues. With the ongoing pandemic, hospitals need to consider conservation strategies to facilitate resource-efficient salbutamol delivery and reduce their waste. In this current opinion, we demonstrate several strategies for avoiding pMDI wastage that can be adopted in both the hospital and community settings. These strategies include reprocessing used or expired pMDIs, using intravenous salbutamol and other short acting inhalers when available, and prescribing maintenance inhalers to prevent over usage of salbutamol pMDIs. We also highlight the important role of physicians and pharmacists in optimizing medication therapies to ensure adequate supplies.

Evaluating an inpatient deprescribing initiative at a rural community hospital in Ontario.

BACKGROUND: Deprescribing is an effective means to reduce polypharmacy in elderly patients. However, geriatric day care deprescribing services are challenging to implement in rural regions. In this study, we examined whether a subacute care unit of a rural hospital could deliver a comprehensive and multidisciplinary intervention to promote deprescribing in patients and whether this intervention would succeed in achieving significant and lasting deprescribing results. METHODS: We conducted a cross-sectional analysis of a deprescribing program at a rural hospital in Eastern Ontario, Canada. Participants were 11 patients, aged 65 or older, who were admitted to the hospital's medical/surgical unit or who presented to the emergency department. Clinicians followed a structured, comprehensive and multidisciplinary approach designed to facilitate deprescribing, which concluded with an outcome evaluation at discharge and follow-up phone calls. Outcomes included the frequency and total number of medications successfully removed, reduced, substituted and restarted after discharge and emergency department visits and hospitalizations 6 months before and after the intervention. RESULTS: Of a total 57 deprescribed medications, 38 were eliminated, 8 were switched to a safer alternative, and 11 were dose reduced. Postdischarge deprescribing reversal occurred in only 5 of 57 deprescribed medications. Among the study population, a 59.2% reduction was observed in the combined number of emergency department visits and hospitalizations 6 months after deprescribing. CONCLUSIONS: This feasibility study was successful in showing the potential added value for offering a rehabilitative, subacute care, inpatient, comprehensive and multidisciplinary approach toward patients with complex deprescribing needs. It also showed proof of concept in reducing polypharmacy-induced adverse health outcomes. Can Pharm J (Ott) 2020:153:xx-xx.

Association between Pharmacists' Country of Qualifying Education and Practising in a Hospital Setting: A Cross-Sectional Ontario Study.

Background: It is hypothesized that international pharmacy graduates (IPGs) are underrepresented in more clinically challenging work. Objective: To examine the association between country of qualifying education for pharmacists in Ontario and the likelihood of practising in a hospital setting. Methods: This study was based on publicly available data from the Ontario College of Pharmacists website, specifically records for all Ontario pharmacists with authorization to provide patient care and for whom country of qualifying education and an accredited pharmacy as a place of practice were reported. Pharmacists who met the inclusion criteria were categorized as Canadian graduates or IPGs. The odds ratio (OR) and 95% confidence interval (CI) for reporting hospital pharmacy as a place of practice were estimated by fitting a logistic regression, with adjustment for gender and years since graduation. Results: A total of 14 689 pharmacists were included in the study: 7403 (50.4%) Canadian graduates and 7286 (49.6%) IPGs. These pharmacists worked in a total of 5028 accredited pharmacies (243 hospital pharmacies [4.8%] and 4785 community pharmacies [95.2%]). Among Canadian graduates, 2458 (33.2%) reported at least 1 hospital pharmacy practice site, whereas the proportion was much smaller among IPGs (427, 5.9%). Canadian graduates represented 85.2% (2458/2885) of all pharmacists who reported hospital practice. The estimated crude OR for practice in a hospital pharmacy was 7.98 (95% CI 7.16-8.91), and the adjusted OR was 7.12 (95% CI 6.39-7.98). Conclusions: IPGs may face barriers impeding their ability to practise in a hospital setting. Providing opportunities such as structured clinical training and experiential placements may facilitate integration of IPGs in institutional settings.

Contexte: On émet l'hypothèse que les diplômés internationaux en pharmacie (DIP) sont sous-représentés dans des tâches plus cliniquement exigeantes. Objectif: Étudier l'association entre le pays de formation qualifiante des pharmaciens en Ontario et la probabilité de pratiquer dans un environnement hospitalier. Méthodes: Cette étude se fondait sur des données accessibles au public sur le site Web de l'Ordre des pharmaciens de l'Ontario, plus précisément les dossiers de tous les pharmaciens de l'Ontario autorisés à prodiguer des soins aux patients et pour lesquels le pays de formation qualifiante ainsi qu'une pharmacie accréditée en tant que lieu de pratique étaient signalés. Les pharmaciens répondant aux critères d'inclusion ont été catégorisés en tant que diplômés canadiens ou DIP. Le rapport de cotes (RC) et l'intervalle de confiance (IC) à 95 % pour le signalement de la pharmacie pratiquée en milieu hospitalier ont été estimés en utilisant une régression logistique, tenant compte du sexe et du nombre d'années depuis l'obtention du diplôme. Résultats: Un total de 14 689 pharmaciens ont été inclus dans l'étude : 7403 (50,4 %) diplômés canadiens et 7286 (49,6 %) DIP. Ces pharmaciens travaillaient dans 5028 pharmacies accréditées au total (243 pharmacies en milieu hospitalier [4,8 %] et 4785 pharmacies communautaires [95,2 %]). Parmi les diplômés canadiens, 2458 (33,2 %) ont signalé au moins un site de pratique en pharmacie hospitalière, tandis que la proportion était beaucoup plus faible parmi les DIP (427, 5,9 %). Les diplômés canadiens représentaient 85,2 % (2458/2885) de tous les pharmaciens ayant signalé une pratique de la pharmacie en milieu hospitalier. Le rapport de cotes (RC) brut estimé pour la pratique en pharmacie en milieu hospitalier était de 7,98 (IC à 95 % 7,16­8,91), et le RC ajusté était de 7,12 (IC à 95 % 6,39­7,98). Conclusions: Les DIP peuvent être confrontés à des obstacles qui entravent leur capacité à exercer dans un environnement hospitalier. Offrir des occasions, comme des formations cliniques structurées et des stages expérientiels, pourrait faciliter leur intégration dans des milieux institutionnels.

Evaluation of a community-based memory clinic in collaboration with local hospitals to support patients with memory decline.

Objective: This study evaluates the role of a specialised and multidisciplinary healthcare team, including a pharmacist, in providing medication management for patients with mild cognitive impairment (MCI) and dementia, in a memory clinic. Methods: The study analysed the dataset of 102 patients of a geriatric and memory clinic in a rural area of Ontario, Canada. The case histories of the patients were reviewed a week before the clinic day and a pharmacist performed medication reconciliations. During the clinic day, cognitive tests were conducted and outcomes were discussed with the team, to create a care plan and schedule a follow-up within 3, 6 or 12 months. Results: Most patients had an average of 5 prescriptions and 2 non-prescription medications deprescribed, and 57% of patients were started on memory-related medications. A total of 712 medications (p-value 0.001) were deprescribed, with 510 prescriptions and 202 non-prescription items. Out of the 712 deprescribed drugs, 374 were discontinued with no therapeutic substitutions, 202 were reduced in dosage and 136 were switched to a safer alternative. A total of 43 patients showed improved Activities of Daily Living (ADL) performance after 3 and 6 months and 68 patients showed improvement after 12 months. Conclusion: This study highlights the importance of a multidisciplinary approach in addressing drug-therapy problems, medication optimisation, and deprescription in patients with dementia. The presence of a pharmacist in the multidisciplinary team enables impactful medication optimisation and leads to improved patient outcomes. This demonstrates the value of specialised expertise in medication management for patients with dementia.

Amid COVID-19 pandemic: Challenges with access to care for COPD patients.

Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammation in the lungs that causes obstruction in the airway, poor airflow, and irreversible loss of lung function. In clinical practice, comprehensive care for COPD patients includes the diagnosis using spirometry, clinical examination and comprehensive pharmacological and non-pharmacological management. The diagnosis is based on symptoms, dyspnea and lung function impairment and can be mild to very severe. Symptoms are examined using the COPD assessment test (CAT) score, and dyspnea grade are examined using a modified MRC from GOLD guidelines. When mild, the care includes self-management education, smoking cessation, lifestyle modifications, vaccination, and short-acting bronchodilators. Self-management education involves inhaler device training, breathing technique, early recognition of acute exacerbations and writing action plans. As the disease progresses, other care measures are added. These measures include the addition of long-acting inhaler therapies, pulmonary rehabilitation, oral therapies, oxygen and lung transplantation. During the final stages of COPD, patients receive end-of-life care (Bourbeau et al., 2019).1 The novel coronavirus disease (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that is spread through respiratory droplets. This infectious disease has led to a pandemic and is affecting the lives of many around the world, including Canadians. During this pandemic, the non-essential health services, including caring for patients with COPD, have been put on hold to reduce the risk of spread. Other implications of this pandemic for COPD patients include the health risk in case of infection. A meta-analysis including studies from January to March 2020 in Wuhan showed that pre-existing COPD worsens the risk of COVID-19 progression and leads to poorer prognostics. The sub-group analysis showed a significantly higher risk of ICU requirements and death in COPD patients who are infected with the SARS-CoV-2 virus. Studies suggest strong efforts to mitigate the risk of infection in this population (Zhao et al., May 2020).2 This makes caring for this population even more critical during the pandemic.

Development and evaluation of an online medication safety module for medical students at a rural teaching hospital: the Winchester District Memorial Hospital.

OBJECTIVE: To design, implement and assess an online learning module for third-year and fourth-year medical students addressing medication safety. DESIGN: This study was a prospective, parallel, open-label, randomised controlled trial with two arms: (1) a control arm in which students were given five articles to read about medication safety, and (2) an intervention arm in which students were given access to an interactive web-based learning module on medication safety. Pretesting and post-testing were done online to evaluate change in medication safety knowledge. RESULTS: Ten students completed the study in the intervention group (online module) and six students completed the study in the control group. The increase in score obtained on the post-test, relative to the pretest, was 15.4% in the group who completed the online module and 2.0% in the control group (difference=13.4%, 95% CI 0.5% to 26.2%, p=0.04). CONCLUSION: Students who completed an online educational tool about medication safety demonstrated a significantly greater increase in knowledge than those who completed a few readings. Online learning modules can be a convenient and effective means of teaching safe prescribing concepts to medical trainees.

Treatment of Clostridium difficile infection in community teaching hospital: a retrospective study.

OBJECTIVES: Clostridium difficile infection (CDI) is responsible for 15-25% cases of health-care-associated diarrhea. The CDI treatment algorithm used at our hospital is adapted from the Infectious Diseases Society of America 2010 C. difficile guideline. The primary objective of this study was to assess the treatment adherence to our algorithm; this was defined as therapy consisting of the appropriate antibiotic, dose, route, interval, and duration indicated based on the disease severity and episode within 24 h of diagnosis. Furthermore, our study also described the population and their risk factors for CDI at our hospital. METHODS: This was a single-centre, retrospective cohort chart review of CDI cases that were diagnosed at admission or during hospitalization from June 1st, 2017 to June 30th, 2018. Cases were identified by a positive stool test along with watery diarrhea or by colonoscopy. RESULTS: Sixty cases were included, of which adherence to our algorithm was 50%. Overall, severe CDI had the highest treatment non-adherence (83%), and the biggest contributing factor was prescribing the wrong antibiotic (72%). In severe CDI, which warrants vancomycin monotherapy, wrong antibiotic consisted of metronidazole monotherapy (55%) or dual therapy with metronidazole and vancomycin (45%). Patients were mostly older, females being treated for an initial episode of mild-to-moderate CDI. Common risk factors identified were age over 65 years (80%), use of antibiotics (83%) and proton pump inhibitors (PPI) (68%) within the previous 3 months. The use of a PPI in this study, a modifiable risk factor without a clear indication, was 35%. CONCLUSION: An area for antimicrobial stewardship intervention in CDI treatment at our hospital is prescribing the right antibiotic based on the CDI indication. In severe CDI, an emphasis should be on prescribing vancomycin monotherapy as the drug of choice. PPI use should be reassessed for tapering when appropriate.

Importance of medication reconciliation in cancer patients.

Cancer patients are a complex and vulnerable population whose medication history is often extensive. Medication reconciliations in this population are especially essential, since medication discrepancies can lead to dire outcomes. This commentary aims to describe the significance of conducting medication reconciliations in this often-forgotten patient population. We discuss additional clinical interventions that can arise during this process as well. Medication reconciliations provide the opportunity to identify and prevent drug-drug and herb-drug interactions. They also provide an opportunity to appropriately adjust chemotherapy dosing according to renal and hepatic function. Finally, reconciling medications can also provide an opportunity to identify and deprescribe inappropriate medications. While clinical impact appears evident in this landscape, evidence of economic impact is lacking. As more cancer patients are prescribed a combination of oral chemotherapies, intravenous chemotherapies and non-anticancer medications, future studies should evaluate the advantages of conducting medication reconciliations in these patient populations across multiple care settings.

Impact of an educational training program on pharmacists' documentation practice at a teaching hospital.

OBJECTIVES: This study aims to determine the impact of an educational training program on the quantity and quality of the pharmacists' documentation practice at the Winchester District Memorial Hospital. METHODS: This study is a part of an evaluation for continuous quality improvement, performed applying a pre- and post-test model. The primary endpoint was the number of Pharmacists' Patient-Care Records in patient charts with the listed action codes. Charts of 80 patients were surveyed at three points (two months before and one and three months after the sessions) for 240 charts. Additionally, a pre- and post-educational questionnaire was administered using case scenarios and the Pharmacists' Patient-Care Record code system. RESULTS: The number of charts containing Pharmacists' Patient-Care Records with Action Codes listed is 70%, 73%, and 64% in the first, second, and third chart review rounds, respectively. According to the pre- and post-educational session questionnaire, the average score per pharmacist is 47% and 73%, respectively. CONCLUSION: The initial estimate of the documentation practice is 50% or less, which is an underestimation. Furthermore, the quantity of pharmacists' documentation is not significantly affected by the educational sessions; however, the quality is improved.

Barriers to conducting deprescribing in the elderly population amid the COVID-19 pandemic.

Deprescribing aims to reduce polypharmacy, especially in the elderly population, in order to maintain or improve quality of life, reduce harm from medications, and limit healthcare expenditure. Coronavirus disease (COVID-19) is an infectious disease that has led to a pandemic and has changed the lives many throughout the world. The mode of transmission of this virus is from person to person through the transfer of respiratory droplets. Therefore, non-essential healthcare services involving direct patient interactions, including deprescribing, has been on hiatus to reduce spread. Barriers to deprescribing before the pandemic include patient and system related factors, such as resistance to change, patient's knowledge deficit about deprescribing, lack of alternatives for treatment of disease, uncoordinated delivery of health services, prescriber's attitudes and/or experience, limited availability of guidelines for deprescribing, and lack of evidence on preventative therapy. Some of these barriers can be mitigated by using the following interventions:patient education, prioritization of non-pharmacological therapy, incorporation of electronic health record (EHR), continuous prescriber education, and development of research studies on deprescribing. Currently, deprescribing cannot be delivered through in person interactions, so virtual care is a reasonable alternative format. The full incorporation of EHR throughout Canada can add to the success of this strategy. However, there are several challenges of conducting deprescribing virtually in the elderly population. These challenges include, but are not limited, to their inability to use technology, lack of literacy, lack of assistance from others, greater propensity for withdrawal effects, and increased risk of severe consequences, if hospitalized. Virtual care is the future of healthcare and in order to retain the benefits of deprescribing, additional initiatives should be in place to address the challenges that elderly patients may experience in accessing deprescribing virtually. These initiatives should involve teaching elderly patients how to use technology to access health services and with technical support in place to address any concerns.

Avoiding a Med-Wreck: a structured medication reconciliation framework and standardized auditing tool utilized to optimize patient safety and reallocate hospital resources.

BACKGROUND: The incidence of preventable adverse drug events (ADE) is approximately one medication error per patient per hospital-day. A quality medication reconciliation (MedRec) process is a crucial intervention used to reduce ADE in the hospital and community setting. Amid the coronavirus disease 2019 (COVID-19) pandemic, preventing medication errors is vital to avoid patient readmission, reduce disease complications, and reduce cost and patient burden on the healthcare system. OBJECTIVES: To develop a standardized MedRec framework that can be implemented in all healthcare settings to reduce patient and staff harm during COVID-19. Also, to create a standardized auditing tool used to assess the quality of the MedRec process and allow for continuous quality improvement. METHODS: A multi-site gap analysis (MGA) was performed to collect observational data that were collected from four different healthcare sites (two hospitals, a long-term care facility, and a community pharmacy). MGA consists of collecting data across several sites which answer a standardized questionnaire. A standardized MedRec framework and auditing tool were developed based on the gaps observed in each site and literature reviews. RESULTS: A standardized MedRec process was not implemented in any of the observed sites. The healthcare sites lacked a designated MedRec team and training related to the MedRec process leading to multiple discrepancies at discharge. Patients were not counselled on changes to home medications, and a discharge report was often not provided upon discharge. Communication mechanisms between community pharmacies and hospital physicians are not available or easily accessible. CONCLUSION: The proposed structured MedRec framework is vital to reduce medication errors and patient harm amid COVID-19. Moreover, the comprehensive auditing tool developed in this study allows for continuous quality improvement resulting in superior quality care, reduction of workflow inefficiencies, cost savings on hospital readmissions, and overall enhanced healthcare system performance.

Student readiness to apply pharmacotherapy concepts to institutional early practice experience - a pilot study.

INTRODUCTION: In order to gain exposure to hospital practice earlier in the education of doctor of pharmacy students, a recent curricular change by the faculty of pharmacy prioritized institutional sites for year two early practice experiences (EPE2s). The goal of this study was to assess whether year two student pharmacists were adequately equipped by the faculty to apply clinical concepts when providing direct patient care in an institutional setting. METHODS: At the study institution, four students rated the relevancy of clinical concepts covered in five pharmacotherapy courses to their EPE2 practice using a relevance score tool. Students self-evaluated their ability-to-practice (AP) these concepts at the start and end of the rotation using an AP score tool. RESULTS: The students determined that all pharmacotherapy courses covered at least one clinical concept that was occasionally seen and applied to practice at the study institution, except for dermatology/ears, eyes, nose, and throat. All AP scores for relevant clinical concepts improved post-rotation except for dyslipidemia, which remained unchanged. CONCLUSIONS: The year two students who participated in the pilot study had sufficient knowledge to apply pharmacotherapy concepts when performing supervised direct patient care at the study institution.

Fournier's gangrene with dapagliflozin in a rural hospital: a case report.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors, which are used for treatment of type 2 diabetes, are associated with risk of urogenital infections. FDA issued a black box warning about multiple case reports of Fournier's gangrene (FG) observed in patients taking SGLT2 inhibitors. FG is a type of necrotising fasciitis that occurs in the anogenital area. We report a case of a 71-year-old woman with type 2 diabetes on dapagliflozin, presenting with foul-smelling discharge and a large abscess in the perianal area. Her risk factors for FG included her advanced age, obesity, diabetes and trauma to the site. During her stay, dapagliflozin was discontinued and she received procedural debridement, wound care and broad-spectrum intravenous antibiotics. Due to possible association between FG and SGLT2 inhibitors, patients presenting with signs and symptoms of FG who are taking SGLT2 inhibitors should be examined for infection in the urogenital area and treated promptly.

Sterilization plan of the used metered dose inhalers (MDI) to avoid wastage amid COVID-19 pandemic drug shortage.

Background Coronavirus is causing a shortage of critical inhalers needed by patients with Asthma and respiratory illness. Patients with Asthma are at higher risk if they tract the novel Coronavirus. As the coronavirus continues to spread, hospitals are turning to use more salbutamol MDI. Salbutamol MDI has become the line of defence for physicians in the emergency room who are treating patients with Corona Virus Disease 2019 (COVID-19) and have respiratory distress .[Hui et al 2020 ,and Center for Drug Evaluation and Research 2020] During the COVID pandemic, there has been a drastic increase in the use of MDI inhalers; therefore, it led to a decrease in availability and a break in the supply chain. Patients with Asthma are at higher risk if they tract the novel Coronavirus, and an inhaler could be a life or death for them. As the coronavirus continues to spread, hospitals are turning to use more salbutamol Metered Dose inhaler (MDI). Salbutamol MDI is now on short supply as the COVID-19 continues to spread. Salbutamol MDI has become the line of defence for physicians in the emergency room who are treating patients with COVID-19 and have respiratory distress. The current shortage of salbutamol MDI could be a result of stockpiling and hoarding of this life-saving inhaler. That had led to a critical shortage of Salbutamol MDI, and even the case shortage continues with some other alternatives such as Ipratropium MDI and even with long-acting B-agonists such as Salmeterol and Formoterol which also starting to have a limitation on ordering these agents. Coronavirus sparks fear of medication shortage. Coronavirus panic-buying also may have led to a shortage of critical inhalers. We have also got elderly patients with COPD who may need Ventolin MDI and also premature babies who may have caught Respiratory Syncytial Virus (RSV) and need salbutamol MDI to support their lungs have since been compromised, and they rely heavily on Asthma inhalers. Finding a safe and creative strategy is essential during the COVID-19 pandemic.

Pharmacist intervention amid the coronavirus disease 2019 (COVID-19) pandemic: from direct patient care to telemedicine.

The coronavirus disease (COVID-19) pandemic has placed enormous pressures on the Canadian healthcare system. Patients are expected to stay home in order to contain the spread of the virus, but understandably have numerous questions and concerns about their health. With physical distancing being of utmost importance during the pandemic, much of healthcare has been forced to move online or over the telephone. Virtual healthcare, in the form of video calls, email, or telephone calls with patients, can significantly enhance access to healthcare. Many clinics have moved their appointments online, and physicians are seeing their patients by means of online video calls. Similarly, patients are refilling their prescriptions online and calling pharmacists whenever they have questions about their medications or medical conditions. Pharmacists are considered the most accessible primary care providers, so it is crucial for patients to know that pharmacists are there to support them throughout the pandemic.

Evaluation of the prophylaxis and treatment of COVID-associated coagulopathy.

Most of the current "literature" surrounding the presence of thrombosis in COVID-19 disease and appropriate prophylaxis/treatment modalities is certainly retrospective at best, and anecdotal at worst. But in these times of rapidly changing information and perspective, an assessment of all available data (including expert opinion) is the goal of this review. Bleeding risk factors for COVID-19-associated bleeding may include other systemic diseases, including hypertension, diabetes, cardiovascular disease, and immunosuppression. Individuals with hypertension should not discontinue their medication. Current evidence does not support changes in the management of hypertension. As COVID-19 progresses, coagulation pathways are activated as part of the host inflammatory response to limit the viral infection. Specifically, D-dimers, products of fibrin as it is degraded within clots, are elevated in many cases of hospitalized COVID-19 patients. D-dimers are an indicator of a clot (thrombus) formation and breakdown. More severe COVID-19 disease may lead to overt disseminated intravascular coagulation (DIC), associated with high mortality. DIC is a coagulopathy that may arise from the systemic inflammatory response to the virus and damaged tissue caused by the infection. Bleeding risk factors may include other systemic diseases, including hypertension, diabetes, cardiovascular disease, and immunosuppression. Individuals with hypertension should not discontinue their medication. Current evidence does not support changes in the management of hypertension. As COVID-19 progresses, coagulation pathways are activated as part of the host inflammatory response to limit the viral infection. Specifically, D-dimers, products of fibrin as it is degraded within clots, are elevated in many cases of hospitalized COVID-19 patients. D-dimers are an indicator of a clot (thrombus) formation and breakdown. More severe COVID-19 disease may lead to overt disseminated intravascular coagulation (DIC), associated with high mortality. DIC is a coagulopathy that may arise from the systemic inflammatory response to the virus and damaged tissue caused by the infection. My manuscript presents the risk and evidence around the COVID-19-associated coagulopathies.