COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up
Key result
Review outlines COVID-19 thrombosis pathogenesis and management to guide antithrombotic therapy choice and dosing.
Why the study?
COVID-19 may predispose patients to arterial and venous thrombotic disease, affecting antithrombotic management, while care for non-COVID-19 patients with thrombotic disease requires optimization during the pandemic.
Key Points
- The aim is to explore the relationship between COVID-19 and thrombotic diseases and their management.
- Reviewed current understanding of pathogenesis and epidemiology of thrombotic disease in COVID-19.
- Examined implications for antithrombotic therapy and treatment adjustments for affected patients.
- COVID-19 can lead to both venous and arterial thrombosis due to inflammation and other factors.
- Patients with pre-existing thrombotic conditions may experience complications if they contract COVID-19.
Structured PICO
P
Population
Patients with COVID-19 at risk for or developing venous or arterial thrombosis, and patients with pre-existing thrombotic disease during the COVID-19 pandemic.
I
Intervention
Antithrombotic therapy and prevention strategies
This review outlines the implications of COVID-19 on the pathogenesis, prevention, and management of venous and arterial thrombotic diseases.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
MGMarcelo GomesVascular medicine specialist, Cleveland Clinic
“Hospitalized patients with severe COVID-19 appear to fall into a higher risk category for DVT/PE than one would expect from patients with other viral infections. This means that a differentiated approach to prophylaxis and treatment may be necessary.”
“The new guideline provides recommendations for managing four arterial (pro)thrombotic medical conditions so that when a patient presents with COVID-19 infection either with an acute thrombotic event or a history of them, the clinician will be able to assess the risks and benefits of administering additional medication that may interact with a current antithrombotic, as well as the need for modification of current antithrombotic therapy.”
Implication
Advises caution in antithrombotic choice, dosing, and monitoring for COVID-19 thrombosis; leaves open optimal regimens pending RCTs.
Abstract
Coronavirus disease 2019 (COVID-19), a viral respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may predispose patients to thrombotic disease, both in the venous and arterial circulations, due to excessive inflammation, platelet activation, endothelial dysfunction, and stasis. In addition, many patients receiving antithrombotic therapy for thrombotic disease may develop COVID-19, which can have implications for choice, dosing, and laboratory monitoring of antithrombotic therapy. Moreover, during a time with much focus on COVID-19, it is critical to consider how to optimize the available technology to care for patients without COVID-19 who have thrombotic disease. Herein, we review the current understanding of the pathogenesis, epidemiology, management and outcomes of patients with COVID-19 who develop venous or arterial thrombosis, and of those with preexisting thrombotic disease who develop COVID-19, or those who need prevention or care for their thrombotic disease during the COVID-19 pandemic.
Discussion
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Cite This Study
Bikdeli et al. (2020) conducted a review in COVID-19 and Thrombotic or Thromboembolic Disease. Antithrombotic therapy and prevention strategies was evaluated. This review outlines the pathogenesis, management, and outcomes of thrombotic disease in patients with COVID-19, highlighting implications for antithrombotic therapy choice, dosing, and monitoring.