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The relationship between coronavirus disease 2019 (COVID-19) and venous thromboembolism events (VTE) was first proposed
in March 2020 as case reports.
Since then, there has been substantial evidence that the two are closely related, with nearly 10,000 articles
published on COVID-19 and VTE in the past two years.
COVID-19 infection is associated with an increased risk of VTE, and the associated factors may be: (i) the predisposition of the virus and induced thrombosis inflammation in severe cases of infection; (ii) conditions of hospitalization (immobilization); (iii) Most of the risk factors for VTE patients are also risk factors
for severe COVID-19.
Previous studies have shown significant benefits in VTE and mortality, particularly in patients
with COVID-19.
This consensus statement systematically reviews the evidence from clinical trials on thromboprophylaxis strategies for COVID-19 patients in different settings (inpatient/outpatient) and aims to provide evidence-based guidelines
for practical issues in clinical practice.
➤Is blood clot prevention beneficial for all hospitalized people with COVID-19?
Thromboprophylaxis is associated with survival benefit (low-dose versus no thromboprophylaxis) and is recommended for all hospitalised patients with COVID-19 who have bleeding risk characteristics and receive the medication
.
➤ What is the preferred drug for thrombosis prevention in hospitalized patients?
For thromboprophylaxis in hospitalised patients with COVID-19, there is more evidence that low-molecular-weight heparin (LMWH) can play a beneficial role and should now be the drug
of choice.
➤What is the optimal dose for thrombosis prevention in hospitalized patients? What is the timing of the launch?
• All hospitalized patients with COVID-19 should receive prompt prophylactic anticoagulation and mechanical prophylaxis
in the setting of high bleeding risk/active bleeding.
• In non-severe (non-ICU) patients at high risk of thrombosis, therapeutic doses of heparin [LMWH/Unfractionated heparin (UFH)]
are recommended to consider the patient's bleeding risk.
Randomized controlled trials have not adequately investigated the effects of
medium-dose heparin in these patients.
• In critically ill (ICU) patients, high doses do not confer benefit and increase the risk of bleeding; Therefore, prophylactic doses should be given, preferably LMWH/UFH
.
➤What is the role of antiplatelet therapy in thromboprophylaxis in hospitalized people with COVID-19?
Antiplatelet agents should not be routinely used to prevent thrombosis and should be considered according to the patient's indication for antiplatelet therapy and risk of thrombosis/bleeding, and concomitant use of anticoagulants
on an individual basis.
➤How to consider the risk of bleeding related to blood clots?
For most hospitalised patients with COVID-19, thromboprophylaxis should be considered an intervention of clinical benefit and low bleeding risk
.
Individualized bleeding risk should be assessed, particularly in patients
with increased dosing.
➤Should outpatients with COVID-19 and post-discharge patients undergo pharmacological interventions to prevent blood clots?
Outpatients
• Routine medication is not recommended for general COVID-19 outpatients to prevent blood clots
.
• After assessing the patient's bleeding risk, appropriate individualized thromboprophylaxis
is recommended for outpatients at high risk of disease exacerbation (adverse prognostic factors for severe disease, potential patients for hospitalization) and/or patients at increased risk of VTE.
• Regular evaluation and reevaluation
for thromboprophylaxis in patients at risk of disease exacerbation and bleeding are strongly recommended.
Patients after discharge
• There are no contraindications to medication, and prophylactic anticoagulation
is recommended for patients at high risk of VTE who receive rivaroxaban 10 mg/day for approximately one month after discharge.
Resources:
Kyriakoulis KG, Dimakakos E, ESVM-European Society of Vascular Medicine et al.
Practical Recommendations for Optimal Thromboprophylaxis in Patients with COVID-19: A Consensus Statement Based on Available Clinical Trials.
J Clin Med.
2022 Oct 11; 11(20):5997.
