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Thromboprophylaxis in Patients with COVID-19: Systematic Review of National and International Clinical Guidance Reports

Author(s):

Konstantinos G Kyriakoulis*, Anastasios Kollias*, Ioannis G Kyriakoulis, Ioanna A Kyprianou, Chrysso Papachrysostomou, Panagiotis Makaronis, Rafail A Kotronias, Dimitrios Terentes-Printzios, Ioannis Toskas and Dimitri P Mikhailidis   Pages 1 - 15 ( 15 )

Abstract:


Background: Venous thromboembolism (VTE) is common among patients with severe coronavirus disease 2019 (COVID-19). Anticoagulation in hospitalized COVID-19 patients has been associated with survival benefit; however, the optimal thromboprophylaxis strategy has not yet been defined.

Objective: To identify published guidance reports by national and international societies regarding thromboprophylaxis strategies in COVID-19 patients in different settings (outpatients, hospitalized, post-discharge).

Methods: A systematic review of the literature (Pubmed/EMBASE) was conducted independently by two investigators.

Results: Among 1942 initially identified articles, 33 guidance documents were included: 20 published by national and 13 by international societies. These documents provide recommendations mainly for hospitalized (97% of reports) and post-discharge (75%) COVID-19 patients, and less so for outpatients (34%). Thrombotic and bleeding risk stratification prior to any treatment decision is the cornerstone of all suggested thromboprophylaxis strategies; 81% of the documents recommend thromboprophylaxis for all hospitalized patients with a prophylactic dosage of low molecular weight heparin irrespective of VTE risk. Intermediate or therapeutic dose intensity is recommended in high VTE risk patients by 56% and 28% of documents, respectively. Mechanical thromboprophylaxis is suggested in case of high bleeding risk or contraindication to pharmacological thromboprophylaxis (59% of documents). Extended pharmacological thromboprophylaxis is recommended for patients with high VTE risk after hospital discharge (63% of documents). For non-hospitalized outpatients, 28% of documents recommend pharmacological thromboprophylaxis for high VTE risk.

Conclusion: The current guidance identifies thromboprophylaxis in COVID-19 patients, especially during hospitalization, as of major importance for the prevention of VTE. Recommendations are derived from limited evidence from observational studies.

Keywords:

Anticoagulation, COVID-19, deep vein thrombosis, guidelines, pulmonary embolism, thromboprophylaxis, venous thromboembolism.

Affiliation:

Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Faculty of Medicine, School of Health Science, University of Thessaly, Larissa, School of Medicine, National and Kapodistrian University of Athens, Athens, Department of Cardiology, General Hospital of Athens “G. Gennimatas”, Athens, Department of Cardiology, General Hospital of Athens “G. Gennimatas”, Athens, Department of Cardiovascular Medicine, University of Oxford, Oxford, Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, Department of Cardiology and Angiology, Faculty of Medicine of the Eberhard Karls University Tübingen, Tübingen, Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL)



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