Safety and Efficacy Analysis of Apixaban Compared to Heparins in Hospitalized Non-Critically Ill COVID-19 Patients.

Purpose: Heparin-based regimens are recommended for anticoagulation in hospitalized patients with COVID-19 though a study reported similar mortality with apixaban in critically ill hospitalized COVID-19 patients. Our pilot study sought to determine the differences in all-cause mortality, venous thromboembolism (VTE), and bleeding events between apixaban and therapeutic heparin-based regimens in hospitalized non-critically ill COVID-19 patients. Methods: We conducted a retrospective analysis of non-critically ill COVID-19 patients aged ≥ 18 years admitted to 3 campuses of Montefiore Medical Center during the first (March 2020 to May 2020) and second (January 2021 to February 2021) COVID-19 surges, who received within 48 hours of admission and continued for ≥72 hours a therapeutic dose of low-molecular-weight heparin (LMWH), unfractionated heparin (UFH), or any apixaban dose for VTE prophylaxis. Outcomes data analyzed included mortality, suspected or imaging-confirmed VTE, and bleeding using a defined criteria. Results: Overall, 162 patients met eligibility for analysis. Baseline characteristics were similar between the 2 groups except liver and renal functions. Mortality occurred in 10 (13.3%) patients on apixaban and 23 (26.4%) patients on a heparin-based regimen (P = .059). Confirmed VTE events were not different between the groups (8% vs 13.8%, P = .359), but higher incidence of bleeding occurred in heparin-based group (4% vs 52.9%, P < .001). Conclusion: There were no differences in mortality or confirmed VTE between apixaban and heparin-based regimens except for more bleeding events with the heparins. This study highlights the utility of apixaban in COVID-19.

CE: Using Smart IV Infusion Pumps Outside of Patient Rooms.

ABSTRACT: The COVID-19 pandemic has created unique challenges for health care workers, who have demonstrated dedication, collaboration, and innovation in response. In this article, the authors describe an important nursing innovation they employed at Montefiore Medical Center in the Bronx, New York, during the spring 2020 COVID-19 surge: the relocation of smart IV infusion pumps outside of patient rooms. The goals of this innovation were to improve delivery of care, conserve personal protective equipment, limit the spread of the virus, and protect staff from exposure. The authors discuss the initial concerns that arose regarding the safety and efficacy of this practice; the research they conducted with other colleagues in nursing, pharmacy, infection control, and patient safety in the face of scant clinical literature relevant to the difficult circumstances the pandemic created; and the strategies they ultimately employed to ensure that this practice maintained safety and efficacy.