Anti-coagulant and anti-platelet therapy in the COVID-19 patient: a best practices quality initiative across a large health system

Abstract

The coronavirus disease 2019 (COVID-19) pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged health-care systems and physicians worldwide to attempt to provide the best care to their patients with an evolving understanding of this unique pathogen. This disease and its worldwide impact have sparked tremendous interest in the epidemiology, pathogenesis, and clinical consequences of COVID-19. This accumulating body of evidence has centered around case series and often empiric therapies as controlled trials are just getting underway. What is clear is that patients appear to be at higher risk for thrombotic disease states including acute coronary syndrome (ACS), venous thromboembolism (VTE) such as deep vein thrombosis (DVT) or pulmonary embolism (PE), or stroke. Patients with underlying cardiovascular disease are also at higher risk for morbidity and mortality if infected. These patients are commonly treated with anticoagulation and/or antiplatelet medications and less commonly thrombolysis during hospitalization, potentially with great benefit but the management of these medications can be difficult in potentially critically ill patients. In an effort to align practice patterns across a large health system (Jefferson Health 2,622 staffed inpatient beds and 319 intensive care unit (ICU) beds across 14 facilities), a task force was assembled to address the utilization of anti-thrombotic and anti-platelet therapy in COVID-19 positive or suspected patients. The task force incorporated experts in Cardiology, Vascular Medicine, Hematology, Vascular Surgery, Pharmacy, and Vascular Neurology. Current guidelines, consensus documents, and policy documents from specialty organizations were used to formulate health system recommendations. Objective: Our goal is to provide guidance to the utilization of antithrombotic and antiplatelet therapies in patients with known or suspected COVID-19.

The role of anti-hypertensive treatment, comorbidities and early introduction of LMWH in the setting of COVID-19: A retrospective, observational study in Northern Italy

“…Recent best practices have been published to aid health-care professionals to determine the proper anti-coagulant and anti-platelet therapy in COVID-19 patients [ 32 ]. Based on our findings, it appears that timely administration of LMWH is of greater importance as compared to initiation of treatment with antivirals, antibiotics and hydroxychloroquine in order to prevent potential thromboembolic events.…”

The role of host defences in Covid 19 and treatments thereof

“…Covid 19 patients are also at higher risk for thrombotic disease states including acute coronary syndrome (ACS), venous thromboembolism (VTE) such as deep vein thrombosis (DVT) or pulmonary embolism (PE), and stroke (Watson et al 1995), which fits with the prognostic value of d-dimer elevation (Zhou et al 2020). Moreover, the clinical conditions are often complicated by the occurrence of Disseminated Intravascular Coagulation (DIC) (Klok et al 2020;Lodigiani et al 2020).…”

Thrombosis and COVID-19: The Potential Role of Nutrition

“…To avoid thrombotic complications, many have recommended prophylactic antithrombotic pharmacological therapies for COVID-19 patients, along with particular dosing instructions (34)(35)(36)(37). However, to date, little research has been conducted and the optimal doses of anticoagulants or antiplatelet agents has yet to be determined.…”

“…In brief, current guidelines proposed by the International Society of Thrombosis and Hemostasis recommend low-molecular weight heparin for both mild and severely infected patients who required hospitalization (40). However, further guidance for the utilization of antithrombotic and antiplatelet therapies in patients with known or suspected COVID-19 are necessary, particularly for patients with comorbidities (36).…”

“…A healthy diet in compliance with current nutritional recommendations can lead to less societal and economic burden to health systems and economies (7,46). Therefore, promotion of a healthy diet and lifestyle among the general population characterized by anti-inflammatory and antithrombotic properties may potentially benefit or prevent the thrombo-inflammatory manifestations of patients with NCDs and comorbidities that can significantly impact the outcomes of COVID-19 patients (7,36,47).…”