Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine.
[en] COVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Gerotziafas, Grigoris T ; Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France ; Research Group Cancer, Haemostasis and Angiogenesis," INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
Catalano, Mariella; Research Center on Vascular Disease & Angiology Unit, Department of Biomedical Science, L Sacco Hospital, University of Milan, Milan, Italy
Colgan, Mary-Paula; Department of Vascular Surgery, St. James's Hospital/Trinity College Dublin, Dublin, Ireland
Pecsvarady, Zsolt; Department of Vascular Medicine, Flor Ferenc Teaching Hospital, Kistarcsa, Hungary
Wautrecht, Jean Claude; Service de Pathologie Vasculaire, Hôpital ERASME, Université Libre de Bruxelle, Brussels, Belgium
Fazeli, Bahare; Immunology Department, Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Sciences, Iran
Olinic, Dan-Mircea; Medical Clinic No. 1, University of Medicine and Pharmacy, Cluj-Napoca, Romania
Farkas, Katalin; Department of Angiology, St. Imre University Teaching Hospital, Budapest, Hungary
Elalamy, Ismail; Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France ; Research Group Cancer, Haemostasis and Angiogenesis," INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France ; Department of Obstetrics and Gynecology, I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
Falanga, Anna; Department of Immunohematology and Transfusion Medicine, & the Thrombosis and Hemostasis Center, Hospital Papa Giovanni XXIII, Bergamo, Italy
Fareed, Jawed; Department of Pathology, Loyola University Medical Center, Maywood, Illinois, United States
Papageorgiou, Chryssa; Service Anesthésie, Réanimation et Médecine Périopératoire, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de médecine, Sorbonne Université, Paris, France
Arellano, Rosella S; Philippine Society of Vascular Medicine, Manila, Philippine
Agathagelou, Petros; Department of Inrterventional Cardiology, American Heart Institute of Cyprus, Nicosia, Cyprus
Antic, Darco; Clinic for Hematology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Auad, Luciana; Medicina Vascular, Sanatorio Allende Córdoba, Ciencias Médicas, Universidad Católica de Córdoba, Argentina
Banfic, Ljiljana; University Hospital Center, School of Medicine University of Zagreb, Croatia
Bartolomew, John R; Cleveland Clinic, Cleveland, Ohio, United States
Benczur, Bela; Balassa Janos County Hospital, University Medical School, Szeged, Hungary
Bernardo, Melissa B; Philippine Society of Vascular Medicine, Manila, Philippine
Boccardo, Francesco; Department of Cardio-Thoracic-Vascular and Endovascular Surgery, Unit of Lymphatic Surgery, IRCCS S. Martino Hospital, University of Genoa, Italy
Cifkova, Renate; Department of Preventive Cardiology, Thomayer Teaching Hospital, Prague, Czech Republic
Cosmi, Benilde; Angiology and Blood Coagulation, Department of Specialty, Diagnostic and Experimental Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
De Marchi, Sergio; Angiology Unit, Cardiovascular and Thoracic and Medicine Department, Verona University Hospital, Verona, Italy
Dimakakos, Evangelos; Vascular Unit of 3rd Department of Internal Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
Dimopoulos, Meletios A; Hellenic Society of Hematology, Athens, Greece ; Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
Dimitrov, Gabriel; Research Center on Vascular Disease & Angiology Unit, Department of Biomedical Science, L Sacco Hospital, University of Milan, Milan, Italy
Durand-Zaleski, Isabelle; Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l'Hôtel Dieu, Paris, France
Edmonds, Michael; Diabetic Foot Clinic, King's College Hospital, London, United Kingdom
El Nazar, Essam Abo; Departement of Surgery, Ministry of Health, Saudi Arabia
Erer, Dilek; Department of Cardiovascular Surgery, Faculty of Medicine, Gazi University, Besevler/Ankara, Turkey
Esponda, Omar L; Internal Medicine Department, Hospital Perea, Mayaguez, Puerto Rico, United States
Gresele, Paolo; Section of Internal and Cardiovascular Medicine, Department of Medicine, -University of Perugia, Perugia, Italy
Gschwandtner, Michael; MedizinischeUniverstiät Wien, Universitätsklinik für Innere Medizin II, Klinische Abteilung für Angiologie, Vienna, Austria
Gu, Yongquan; Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing China
Heinzmann, Mónica; Medicina Vascular, Sanatorio Allende Córdoba, Ciencias Médicas, Universidad Católica de Córdoba, Argentina
Hamburg, Naomi M; The Whitaker Cardiovascular Institute Department of Medicine Boston University School of Medicine, Boston, Massachusetts, United States
Hamadé, Amer; Vascular Medicine Unit, Internal Medicine Department, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
Jatoi, Noor-Ahmed; Department Vascular Medicine, Mulhouse Hospital Center, Mulhouse, France
Karahan, Oguz; Department of Cardiovascular Surgery, Medical School of Alaaddin Keykubat University, Alanya/Antalya, Turkey
Karetova, Debora; Second Department of Medicine, Department of Cardiovascular Medicine, Charles University in Prague, Prague, Czech Republic
Karplus, Thomas; Department of Vascular Medicine, Concord Repatriation General Hospital, Sydney, Australia
Klein-Weigel, Peter; Klinik für Angiologie, Zentrum für Innere Medizin II, Ernst von Bergmann Klinikum, Potsdam, Germany
Kolossvary, Endre; Department of Angiology, St. Imre University Teaching Hospital, Budapest, Hungary
Kozak, Matija; Department for Vascular Diseases, Medical Faculty of Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia
Lefkou, Eleftheria; Board member of the Institute for the Study and Education on Thrombosis and Antithrombotic Therapy, Athens, Greece
Lessiani, Gianfranco; Angiology Unit, Internal Medicine Department., Città Sant' Angelo Hospital, AUSL 03, Pescara, Italy
Liew, Aaron; Portiuncula University Hospital, Soalta University Health Care Group, National University of Ireland Galway (NUIG), Galway, Ireland
Marcoccia, Antonella; Unità di Medicina Vascolare e Autoimmunità, CRIIS-Centro di riferimento interdisciplinare per la Sclerosi Sistemica, Rome, Italy
Marshang, Peter; Department of Internal Medicine, Central Hospital of Bolzano, Bolzano, Italy
Marakomichelakis, George; Angiology Unit, Evangelismos General Hospital, Athens, Greece
Moraglia, Luc; Angiologie Centre Cours du Médoc, Médecine Vasculaire Travail, Bordeaux, France
Pillon, Sergio; UOSD Angiology, San Camillo-Forlanini Hospital, National Health Institute ISS, Rome, Italy
Poredos, Pavel; Medical Association of Slovenia and SMA, Slovenia Academic Research Centre, Slovenian Medical Academy, Ljubljana, Slovenia
Prior, Manlio; Angiology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
Salvador, David Raymund K; Philippine Society of Vascular Medicine, Manila, Philippine
Schlager, Oliver; Division of Angiology, Department of Internal Medicine 2, Medical University of Vienna, Vienna, Austria
Schernthaner, Gerit; Division of Angiology, Department of Internal Medicine 2, Medical University of Vienna, Vienna, Austria
Sieron, Alexander; Department of Internal Medicine, Angiology and Physical Medicine, Medical University of Silesia, Katowice, Poland ; Specialist Hospital, Bytom, Jan Długosz University in Częstochowa, Częstochowa, Poland
Spaak, Jonas; Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Stockholm County, Sweden
Spyropoulos, Alex; Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Feinstein Institute for Medical Research, New York, New York, United States
Sprynger, Muriel ; Université de Liège - ULiège > Département des sciences cliniques
Suput, Dusan; Center for Clinical Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
Stanek, Agata; Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Bytom, Poland
Stvrtinova, Viera; Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
Szuba, Andrzej; Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland
Tafur, Alfonso; Vascular Medicine University of Chicago, Northshore Cardiovascular Institute, Skokie, Illinois, US Army
Vandreden, Patrick; Research Group Cancer, Haemostasis and Angiogenesis," INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
Vardas, Panagiotis E; Medical School of Crete, University of Crete and Heart Sector, Hellenic Healthcare Group, Athens, Greece
Vasic, Dragan; Department of Noninvasive vascular laboratory, Clinic of Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia
Vikkula, Miikka; Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
Wennberg, Paul; Department of Cardiovascular Medicine, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, United States
Zhai, Zhenguo; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Peking University Health Science Center, Capital Medical University, Beijing, China ; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine.
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