COVID-19; COVID-19 therapeutics; anticoagulation; dosage; mortality; thromboprophylaxis; treatment; Medicine (all)
Abstract :
[en] Coronavirus disease 2019 (COVID-19) has been shown to be strongly associated with increased risk for venous thromboembolism events (VTE) mainly in the inpatient but also in the outpatient setting. Pharmacologic thromboprophylaxis has been shown to offer significant benefits in terms of reducing not only VTE events but also mortality, especially in acutely ill patients with COVID-19. Although the main source of evidence is derived from observational studies with several limitations, thromboprophylaxis is currently recommended for all hospitalized patients with acceptable bleeding risk by all national and international guidelines. Recently, high quality data from randomized controlled trials (RCTs) further support the role of thromboprophylaxis and provide insights into the optimal thromboprophylaxis strategy. The aim of this statement is to systematically review all the available evidence derived from RCTs regarding thromboprophylaxis strategies in patients with COVID-19 in different settings (either inpatient or outpatient) and provide evidence-based guidance to practical questions in everyday clinical practice. Clinical questions accompanied by practical recommendations are provided based on data derived from 20 RCTs that were identified and included in the present study. Overall, the main conclusions are: (i) thromboprophylaxis should be administered in all hospitalized patients with COVID-19, (ii) an optimal dose of inpatient thromboprophylaxis is dependent upon the severity of COVID-19, (iii) thromboprophylaxis should be administered on an individualized basis in post-discharge patients with COVID-19 with high thrombotic risk, and (iv) thromboprophylaxis should not be routinely administered in outpatients. Changes regarding the dominant SARS-CoV-2 variants, the wide immunization status (increasing rates of vaccination and reinfections), and the availability of antiviral therapies and monoclonal antibodies might affect the characteristics of patients with COVID-19; thus, future studies will inform us about the thrombotic risk and the optimal therapeutic strategies for these patients.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Kyriakoulis, Konstantinos G ; Third Department of Medicine, School of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
Dimakakos, Evangelos; Third Department of Medicine, School of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
Kyriakoulis, Ioannis G ; Third Department of Medicine, School of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
Catalano, Mariella; Inter-University Research Center on Vascular Disease, Department of Biomedical Science, L Sacco Hospital, University of Milan, 20157 Milan, Italy
Spyropoulos, Alex C ; Feinstein Institutes for Medical Research, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA ; Department of Medicine Northwell Health, Lenox Hill Hospital, New York, NY 10075, USA
Schulman, Sam ; Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON L8S 4L8, Canada
Douketis, James; Department of Medicine, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON L8S 4L8, Canada
Falanga, Anna ; School of Medicine, University of Milan Bicocca, 20126 Milan, Italy ; Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy
Maraveyas, Anthony; Queens Centre Oncology & Hematology, Faculty of Health Sciences, Hull York Medical School, Cottingham, Hull HU6 7RU, UK
Olinic, Dan-Mircea ; Medical Clinic No. 1, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
Belch, Jill ; Institute of Cardiovascular Research, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
Gerotziafas, Grigorios; Sorbonne University, Institut National de la Santé et de la Recherche Médicale (INSERM), Unit 938, Research Group Cancer, Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), Institut Universitaire de Cancérologie, 75012 Paris, France ; Thrombosis Center, Tenon-Saint Antoine, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris (APHP), 75012 Paris, France
Syrigos, Konstantinos; Third Department of Medicine, School of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
Kollias, Anastasios ; Third Department of Medicine, School of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
COVID-19 Thrombosis Collaborative Group, Endorsed by VAS-European Independent Foundation in Angiology/Vascular Medicine, UEMS Division of Angiology/Vascular Medicine/and ESVM-European Society of Vascular Medicine and Supported by the Balkan Working Group
Sprynger, Muriel ; Université de Liège - ULiège > Département des sciences cliniques
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