An approach to a perceived risk of venous thromboembolism in non-ICU COVID-19 patients in Singapore

Coronavirus disease 2019 (COVID-19) can lead to coagulation activation and venous thromoembolism (VTE), with an incidence of around 25–27%. Patients admitted to the intensive care unit (ICU) are at highest risk. There are not many studies reporting its incidence in non-ICU patients. A large number of COVID-19 patients in Singapore, with symptoms ranging from mild to moderate, have been admitted to either Community Care Facilities (CCF) or in general wards of Public Healthcare Institutions (PHI). In case there is a surge of COVID-19 patients, there is a possibility that general wards in PHIs may need to admit an increasing numbers of acutely ill patients, with only the critical ones being admitted to ICU. The incidence of VTE in non-ICU patients is not exactly known and its detection in these patients is challenging. Thus, the healthcare staff managing these patients at the CCFs and general wards at the PHIs should be vigilant and monitor these patients for development of signs and symptoms of deep vein thrombosis, as well as trend D-dimer level. An algorithm for a potential approach to manage VTE in non-ICU COVID-19 patients is described. A prospective study is needed to establish the incidence of VTE in non-ICU patients in Singapore and the predictive value of D-dimer levels to detect this risk, as well as a therapeutic protocol to initiate appropriate pharmacological thromboprophylaxis in these patients.