Introduction: Venous thromboembolism (VTE) is the leading cause of preventable deaths in hospitalized patients. Prior studies have demonstrated that increasing patient education about VTE increases medication adherence. Thus, standardizing VTE education is an important priority in optimizing patient care. In this regard, online education offers unique advantages as it can be accessed by patients anywhere and anytime. However, an effective VTE educational tool remains elusive as little research has been done to determine what information patients should know or how such information can be delivered most effectively. We performed a qualitative study of hematologists and VTE patients to understand these issues, with the goal of utilizing this information to create an online educational tool for VTE that addresses the needs of both clinicians and patients. Methods: We conducted semi-structured interviews with physicians in the Section of Hematology at Yale School of Medicine (YSM) and VTE patients in the outpatient Benign Hematology Clinic at Yale Cancer Hospital. Adult patients with a pulmonary embolism or deep venous thrombosis, who were on or off anticoagulation, and who were seen in the outpatient clinic either as new patients or for follow-up visits were all included. Providers were asked about what strategies work best when communicating to patients and important aspects of VTE they felt patients should know. Patients were asked about their understanding of VTE and how an educational tool would best address their concerns. All interviews were audio recorded and transcribed. Data were analyzed with grounded theory, and each transcript was double-coded until thematic saturation was achieved. Results: Five physicians participated in the study: one with a focus in benign hematology, three with a focus in benign and malignant hematology, and one who had been a private practice hematology/oncology provider and then transitioned into a clinical appointment on the YSM Hematology faculty. Qualitative analysis from the physician interviews revealed important themes. In particular, physicians believed that an online resource for VTE should: 1) provide visual animation to facilitate conceptual understanding; 2) be readily accessible and as concise as possible; and 3) follow a standardized format that addresses classification of VTE (provoked vs. unprovoked), signs and symptoms of VTE, treatment options, and long-term management. Eight patients were interviewed for the study, 4 with a first episode of VTE and 4 with recurrent VTE. Of these, 7 were on anticoagulation and 1 was not. Most patients indicated that their major source of online health education was through websites - most notably "WebMD." Patients identified websites as helpful in providing background information, but felt that websites were limited in their ability to provide personalized patient-based recommendations. Many also found website text lengthy and felt that concepts could be better conveyed if explained visually in a concise manner. Conclusion: Based on the physician and patient interviews, an optimal online educational tool about VTE should address the pathophysiology, natural history, management, recurrence risk, and prevention of VTE, in a concise and personalized manner, utilizing visual stimuli. We plan on synthesizing this information to create a 5-10 minute animated video about VTE that addresses all of these issues; we then hope to study the efficacy of the video through a randomized control trial. Disclosures No relevant conflicts of interest to declare.

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INTRODUCTION:The known range of complications associated with COVID-19 infection is vast. Cerebral venous thrombosis (CVT) has been reported as a complication of the infection with a frequency of 0.08% and 40% in hospital mortality. Here we present an unusual case of COVID-19 in a healthy young male complicated with CVT and polycythemia. CASE DESCRIPTION:A 33-year-old male with no known past medical history presented with agitation. He was noted to be progressively confused and agitated over 2 days prior to presentation as per significant other. He was febrile and tachycardic on presentation. Labs were remarkable for COVID PCR positivity and hemoglobin of 20.8 mg/dL. CT head revealed dural sinus thrombosis. On admission, he had a witnessed tonic-clonic seizure, which broke with 2 mg lorazepam. He was empirically started on vancomycin, ceftriaxone, and acyclovir after a lumbar puncture was performed and additionally loaded with levetiracetam. On hospital day 2, CT venogram confirmed extensive CVT and therapeutic enoxaparin was initiated. Antibiotics were discontinued on hospital day 3 due to negative CSF studies. Polycythemia on admission at 20.8 mg/dL initially improved with hydration to 19 mg/dL. Due to persistent elevation, he underwent phlebotomy with removal of 200 cc of blood on hospital day 2, which reduced Hb to 15 mg/dL. Workup for thrombophilia returned unremarkable, including factor V Leiden and prothrombin gene mutations, DRVVT, ß2 glycoprotein antibodies, cardiolipin IgA, homocysteine levels, proteins C and S, JAK2V617, EPO, JAK2 exon 12. Hemoglobin continued to rise during hospital stay requiring additional phlebotomy with removal of 400 cc on hospital day 7. He was discharged on hospital day 8 on apixaban. Follow-up with Hematology showed Hb of 16.7 mg/dL with complete resolution of encephalopathy. Further workup for thrombophilia and polycythemia is ongoing.DISCUSSION: Given the novelty of COVID-19, the full range of pathologies of the infection is still being uncovered. Hypercoagulable states found with COVID-19 infections have been previously linked to CVT in young adults, however these are more often complicated by anemia. Our patient's unique presentation of CVT underlined by polycythemia was found to be treatable with phlebotomy, leading to complete resolution of acute encephalopathy.

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