A Delphi consensus on the management of anticoagulation in the COVID-19 pandemic: the MONACO study

Abstract

Background During the COVID-19 pandemic, guideline documents on the management of anticoagulation were rapidly published. However, these documents did not follow a structured methodology, and significant differences existed between the guidelines. The aim of this expert consensus was to provide recommendations on the clinical management of oral anticoagulation in patients in the context of the COVID-19 pandemic. Methods A two-round Delphi study was conducted using an online survey. In the first round, panellists expressed their level of agreement with the items on a 9-point Likert scale. Items were selected if they received approval from ≥66.6% of panellists and if they were agreed by the scientific committee. In the second round, panellists revaluated those items that did not meet consensus in the first round. Results A total of 147 panellists completed the first round, and 144 of them completed the second round. Consensus was reached on 161 items included in five dimensions. These dimensions addressed: (I) management of anticoagulation in patients with atrial fibrillation (AF) without mechanical valves or moderate/severe mitral stenosis during COVID-19 infection; (II) thromboprophylaxis in patients hospitalised for COVID-19; (III) management of anticoagulation at hospital discharge/after COVID-19; (IV) anticoagulation monitoring in the COVID-19 pandemic setting; and (V) role of telemedicine in the management and follow-up of patients with AF in the COVID-19 pandemic setting. Conclusions These areas of collective agreement could specially guide clinicians in making decisions regarding anticoagulation in patients with COVID-19 during hospitalisation and at discharge, where results from clinical trials are still limited and, in some cases, conflicting.

Antithrombotic Use Patterns in COVID-19 Patients from Spain: A Real-World Data Study

“…Recent studies do not support including antiplatelet therapy in the standard care of COVID-19, regardless of its severity or concomitant anticoagulation [21]. However, continuing the chronic use of antithrombotics is internationally recommended, except in the case of significant bleeding or other contraindications [8].…”

“…For instance, thromboprophylaxis with lowmolecular-weight heparin (LMWH) or unfractionated heparin (UFH) is indispensable in hospital-admitted patients. However, they are not recommended for non-hospitalized individuals [7,8]. In addition, anticoagulants used on the wards are not generally continued post-discharge to prevent thromboembolisms, except in cases of high risk of thrombosis or if different indications exist [9].…”