News in brief: Thromboprophylaxis could help minimise VTE risk in hospitalised COVID-19 patients; New Medicare review will continue work of MBS Taskforce; COVID-19 vax link to menstrual changes should be investigated

Thromboprophylaxis could help minimise VTE risk in hospitalised COVID-19 patients

A Victorian hospital has helped minimise venous thromboembolism (VTE) rates in hospitalised COVID-19 patients via a risk-adapted prophylaxis protocol.

A retrospective study of 86 COVID-19 patients admitted to Peninsula Health between March and August 2020 showed dose-adjusted enoxaparin based on disease severity, weight and renal function helped prevent symptomatic VTEs in all patients.

Eighty-one patients received anticoagulants, either through existing treatment or thromboprophylaxis, with 90% adherence to institutional prophylaxis guidelines, the authors wrote in the Internal Medicine Journal.

Bleeding complications were uncommon, with one non-major bleeding event while on therapeutic anticoagulation for pre-existing VTE, and three minor bleeding cases in patients who were on pre-existing therapeutic anticoagulation for stroke progression in atrial fibrillation, an intensified dose of enoxaparin for critical illness or a standard dose of thromboprophylaxis.

“Low rates of VTE were identified in hospitalised COVID-19 patients using a risk-adapted thromboprophylaxis protocol,” they wrote.

“To our knowledge, this is the only report describing such experience in an Australian setting.”

More research is needed to better define VTE risk and optimise thromboprophylaxis, the authors concluded.

New Medicare review will continue work of MBS Taskforce

Professor Anne Duggan has been announced as the chair of a new Medicare Benefits Schedule (MBS) Review Advisory Committee (MRAC) that will continue the overhaul of MBS items started by the MBS Review Taskforce.

The Department of Health says the advisory committee will  “ensure the MBS continues to support high quality care, and remains flexible and contemporary. It  follows the MBS Review Taskforce, which from 2015 to 2020 reviewed more than 5,700 items on the MBS and made recommendations to the minister for health to remove or streamline inappropriate and outdated items, including some for colonoscopy.

Professor Duggan is a gastroenterologist in Newcastle, NSW and Chief Medical Officer for the Australian Commission on Safety and Quality in Health Care, where she provides expert clinical advice to the Commission in its role to improve safety and quality of health care nationally.

COVID-19 vax link to menstrual changes should be investigated

A link between COVID-19 vaccination and menstrual changes is “plausible and should be investigated”, according to Dr Victoria Male, a reproductive specialist at Imperial College London.

In an editorial published in the BMJ, Dr Male said the Medicines and Healthcare products Agency had received 30,000 reports of menstrual and unexpected bleeding post vaccination with both mRNA and adenovirus vectored COVID-19 vaccines.

This number is still considered low given the proportion of people who have received COVID-19 vaccination and the prevalence of menstrual disorders in the general population. Also, in most cases periods have returned to normal by the following cycle, and there is no evidence to suggest that vaccination adversely affects fertility.

However, while menstrual changes and unexpected bleeding are not currently classed as common side effects of COVID-19 vaccination, current data collection methods make it difficult to draw any firm conclusions, Dr Male noted. Instead, she argued that researchers should be using approaches that compare the incidence of menstrual issues across vaccinated and unvaccinated populations.

“Although reported changes to the menstrual cycle after vaccination are short lived, robust research into this possible adverse reaction remains critical to the overall success of the vaccination programme,” she said. “Vaccine hesitancy among young women is largely driven by false claims that COVID-19 vaccines could harm their chances of future pregnancy. Failing to thoroughly investigate reports of menstrual changes after vaccination is likely to fuel these fears.”

While more evidence on a potential link is gathered, clinicians should encourage anybody experiencing menstrual issues post vaccination to report them to the MHRA’s yellow card scheme, Dr Male advised. Any persistent change to periods persisting or new vaginal bleeds post menopause should be managed as per normal clinical guidelines.

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