Hypercoagulable state and COVID 19

MMascarenaz

I have a case scenario of a patient admitted positive for COVID 19 and discharged. Then readmitted for a PE with a negative COVID 19 test result. The clinician documents PE following COVID 19 infection and hypercoagulable state.

Reaching out for any resources, suggestions, feedback r/t Best practice documentation and or current guidance r/t Hypercoagulable state following a COVID 19 infection.

1. False negative with COVID 19 testing: frequency, current practices, what does a positive/negative mean?

2. Is Hypercoagulable status subsequent effect of COVID 19 that on readmission should be diagnosed even though testing is negative?

3. What is the clinical perspective of Hypercoagulable state following COVID 19 infection?

Thanks for any feedback, support and guidance!

morris-jeff@CooperHealth.edu

I have also been wondering about his as our facility started dc'ing patients home on Eliquis. 

Does anyone have the diagnostic criteria for hypercoagulable state? We are drawing D-dimer but not usually clotting factors, etc.. 

Just curious if this is a valid dx for our COVID-19 patient's. 

Thanks,
Jeff

patricia.fountain@umassmemorial.org

i have heard the same.  My daughter is currently working in acute care and said they are seeing hypercoagulopathy and are now preventatively placing pts on anticoags such as Eliquis. Looks like there is some research currently being conducted and published on PubMed. 

Stay safe all,

Patti  

MMascarenaz

Thank you Patti! I will check that out! Our facility is now initiating lab monitoring and prophylactic treatment also for all COVID 19 positive patients and just recently we have began testing all inpatients. Now im curious how many cases may not be represented accurately in relation false negative testing,  clotting such as stroke when it appears that the impact of hypercoagulability can result while the patient is testing negative for COVID 19 with new understanding of a likely link, and/or inaccurate data reporting based on current CMS sequencing for COVID 19 that could send a case with a craniotomy due to an ischemic stroke into a 981 with U07.1 as the PDx. Its my brain running through all the rabbit holes of covid…..

MMascarenaz

jwmorris1 said:

I have also been wondering about his as our facility started dc'ing patients home on Eliquis. 

Does anyone have the diagnostic criteria for hypercoagulable state? We are drawing D-dimer but not usually clotting factors, etc.. 

Just curious if this is a valid dx for our COVID-19 patient's. 

Thanks,
Jeff

Thanks for your collaboration Jeff.....

I find capture of Hypercoagulable state results in D6869 Other thrombophilia when linked to COVID 19 infection based on documentation and capture of Coagulopathy results in D688 Other specified coagulation defects when linked to COVID 19 infection. Based on my research identifying the D-Dimer elevation with continuous monitoring and the prophylactic anticoagulation therapy provides the clinical validity for capture of the diagnosis,https://www.hematology.org/covid-19/covid-19-and-coagulopathy.

 The second area of consideration is capture of the COVID 19 infection.....if positive on admission U07.1 COVID 19, if negative on admission with a recent positive history B948 sequela of other specified infectious and parasitic disease.....here is where clinically I question even though a test is coming back negative is the current admission and coagulopathy/hypercoagulable state not sequalae and actually initial or subsequent COVID 19 infection based on the progression of the infection process.....

This will all be based on documentation and the clinical diagnosis where I am finding a need for clarification.....and the research is currently in process across the world im finding....