Evidence-Based Practical Guidance for the Antithrombotic Management in Patients With Coronavirus Disease (COVID-19) in 2020

Abstract

<jats:p> This practical guidance, endorsed by the Brazilian Society of Thrombosis and Hemostasis and The Brazilian Society of Angiology and Vascular Surgery, the International Union of Angiology and the European Venous Forum, aims to provide physicians with clear guidance, based on current best evidence-based data, on clinical strategies to manage antithrombotic strategies in patients with coronavirus disease 2019. </jats:p>

COVID-19 grave: entenda o papel da imunidade, do endotélio e da coagulação na prática clínica

“…There is a tendency to suggest that prophylaxis should be maintained after hospital discharge, because of the hypercoagulable state triggered by the disease. 50,[60][61][62] There is a risk of bleeding in anticoagulant patients, particularly so as the disease worsens. The profile of DIVC in COVID-19 is initially thrombotic, but it can progress to hemorrhagic as the disease progresses.…”

Papel do Endotélio na COVID-19 Grave

“…Cronicamente, essa fibrina insolúvel contribui para fibrose pulmonar e seus desdobramentos negativos. 8,9,15,17 As principais alterações na coagulação presentes na COVID-19 são: elevação do dímero-D, do fibrinogênio e do tempo de protrombina, e diminuição da fibrinólise. A contagem de plaquetas pode estar reduzida nos estágios mais avançados da doença, sendo fator preditivo de mortalidade.…”

Unpuzzling COVID-19 Prothrombotic State: Are Preexisting Thrombophilic Risk Profiles Responsible for Heterogenous Thrombotic Events?

“…Although thromboprophylaxis for any hospitalized COVID-19 patient is generally accepted, there is an ongoing debate about the exact dosage to be administered. 4,5 Furthermore, the World Health Organization advises for a pharmacological prophylaxis of thromboembolism in hospitalized COVID-19 patients but warns on carefully considering the significant side-effects and drug-drug interactions that may affect COVID-19 symptomatology. 6 Especially among critically ill patients or patients developing acute respiratory distress syndrome (ARDS) shortly after COVID-19 onset, the need for anticoagulation is justified by the mechanism and the consequences of the alveolar injuries that occur during the viral attack when characteristically neutrophil-platelet aggregates are formed.…”

“…Although thromboprophylaxis for any hospitalized COVID-19 patient is generally accepted, there is an ongoing debate about the exact dosage to be administered. 4 , 5 Furthermore, the World Health Organization advises for a pharmacological prophylaxis of thromboembolism in hospitalized COVID-19 patients but warns on carefully considering the significant side-effects and drug-drug interactions that may affect COVID-19 symptomatology. 6…”