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Important COVID-19 Updates: Anticoagulation in Pregnancy, Notifying Deaths, Antivirals & Updated DHB Policy

Increased VTE risk with COVID-19 in Pregnancy: Anticoagulation may be Required

COVID-19 infection during pregnancy leads to an increased risk of venous thromboembolism. Anticoagulation with enoxaparin (Clexane) may be required.

If you are caring for a patient who is pregnant and contracts COVID-19, please send a BPAC eReferral to the obstetric service at BOP DHB. They will rapidly triage the referral and make a decision on VTE risk and anticoagulation. If anticoagulation is required, they will arrange for an RMO to provide the prescription for the patient.
Please include the weight, height and BMI of the patient in the referral.
If you are prescribing anticoagulation yourself, please still send an eReferral to notify the obstetric service so that a register can be maintained of pregnant patients with COVID-19.
A reminder to notify the medical officer of health about COVID-related deaths
Under Section 74 of the Health Act, it is our legal responsibility to notify the medical officer of health where we suspect a patient’s death may be related to COVID-19. 
The medical officer of health will then collate the required data about the case for forwarding to the Ministry of Health.

Antiviral medications for COVID-19 infection: update
Remdesivir is an intravenous antiviral agent that may be useful in some patients if given within 7 days of symptom onset. In community patients with symptomatic COVID-19, Remdesivir may prevent hospitalisation in those who are at risk of severe disease.
However, the ability to deliver this medication poses significant logistical and workforce considerations, and may not be reasonably practicable. If you feel your patient meets the criteria for administration of remdesivir, please contact the Infectious Disease SMO on-call at BOP DHB to discuss the next steps.

An oral alternative is likely to become available in the coming weeks.

See here for information on inclusion criteria: Updated changes to the access criteria for remdesivir for COVID-19 – Pharmac | New Zealand Government.
Update to DHB policy on notifiable diseases
The DHB’s policy on notifiable diseases has been updated as part of the regular review cycle. It will be available on the health professionals’ section of the Toi Te Ora website, and via the link below.

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