Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum

Abstract

Coronavirus disease 2019 (COVID-19) is a viral infection that can, in severe cases, result in cytokine storm, systemic inflammatory response and coagulopathy that is prognostic of poor outcomes. While some, but not all, laboratory findings appear similar to sepsis-associated disseminated intravascular coagulopathy (DIC), COVID-19-induced coagulopathy (CIC) appears to be more prothrombotic than hemorrhagic. It has been postulated that CIC may be an uncontrolled immunothrombotic response to COVID-19, and there is growing evidence of venous and arterial thromboembolic events in these critically ill patients. Clinicians around the globe are challenged with rapidly identifying reasonable diagnostic, monitoring and anticoagulant strategies to safely and effectively manage these patients. Thoughtful use of proven, evidence-based approaches must be carefully balanced with integration of rapidly emerging evidence and growing experience. The goal of this document is to provide guidance from the Anticoagulation Forum, a North American organization of anticoagulation providers, regarding use of anticoagulant therapies in patients with COVID-19. We discuss in-hospital and post-discharge venous thromboembolism (VTE) prevention, treatment of suspected but unconfirmed VTE, laboratory monitoring of COVID-19, associated anticoagulant therapies, and essential elements for optimized transitions of care specific to patients with COVID-19.

Eosinophil and Anticoagulation in COVID-19 Patients

“…COVID-19 infection has been shown to be associated with increased coagulopathy [12,17,18]. In these patients, the D-dimer and brinogen levels were increased but aPTT level was decreased [19].…”

Elevated Eosinophil Count Is Related With Lower Anti-Factor Xa Activity In COVID-19 Patients

“…Patients with lung conditions were found to have increased in ammatory parameters and percentage of eosinophils. COVID-19 infection has been shown to be associated with increased coagulopathy [14,19,20]. In these patients, the D-dimer and brinogen levels were increased but aPTT level was decreased [21].…”

“…However, the dose that can be used has not been clari ed. Previous studies have shown that heparin prophylaxis reduces thromboembolic events in COVID-19 patients [14]. However, the e cacy of heparin prophylaxis in COVID-19 patients, as determined by laboratory data, and the factors affecting this e cacy are not known.…”

Consensus Scientific Statement on Advisory Working Guidelines and Recommendations for the Female Population in COVID-19 Era by WINCARS

“…However, COVID-19induced coagulopathy (CIC) appears to be more prothrombotic than hemorrhagic. 132 Though specific thrombolytic therapy data on COVID-19-positive pregnant stroke patients is not available, it seems reasonable that the eligible pregnant stroke patients should benefit from thrombolytic therapy. Risks of additional bleeding should be assessed in menstruating women with stroke before offering thrombolytic therapy (class IIb, level C-LD).…”

“…Cerebral venous sinus thrombosis due to SARS-CoV-2 infection has been reported repeatedly during this pandemic. [131][132][133] Oral contraceptive pills (OCP) consumption is a well-recognized risk factor for development of CVT. 134 Increased thrombosis is expected if both the risk factors are combined (class IIa, level C).…”