Thromboembolic risk and anticoagulant therapy in COVID-19 patients: emerging evidence and call for action

Br J Haematol. 2020 Jun;189(5):846-847. doi: 10.1111/bjh.16727. Epub 2020 May 4.

Abstract

Emerging evidence shows that severe coronavirus disease 2019 (COVID-19) can be complicated with coagulopathy, namely disseminated intravascular coagulation, which has a rather prothrombotic character with high risk of venous thromboembolism. The incidence of venous thromboembolism among COVID-19 patients in intensive care units appears to be somewhat higher compared to that reported in other studies including such patients with other disease conditions. D-dimer might help in early recognition of these high-risk patients and also predict outcome. Preliminary data show that in patients with severe COVID-19, anticoagulant therapy appears to be associated with lower mortality in the subpopulation meeting sepsis-induced coagulopathy criteria or with markedly elevated d-dimer. Recent recommendations suggest that all hospitalized COVID-19 patients should receive thromboprophylaxis, or full therapeutic-intensity anticoagulation if such an indication is present.

Keywords: SARS-CoV-2; anticoagulant; prophylaxis; thromboembolism; thrombosis.

MeSH terms

  • Anticoagulants / administration & dosage*
  • Betacoronavirus*
  • Coronavirus Infections* / blood
  • Coronavirus Infections* / drug therapy
  • Coronavirus Infections* / epidemiology
  • Disseminated Intravascular Coagulation / blood
  • Disseminated Intravascular Coagulation / drug therapy
  • Disseminated Intravascular Coagulation / epidemiology
  • Disseminated Intravascular Coagulation / virology
  • Female
  • Fibrin Fibrinogen Degradation Products / metabolism*
  • Humans
  • Incidence
  • Male
  • Pandemics*
  • Pneumonia, Viral* / blood
  • Pneumonia, Viral* / drug therapy
  • Pneumonia, Viral* / epidemiology
  • Risk Factors
  • Venous Thromboembolism* / blood
  • Venous Thromboembolism* / drug therapy
  • Venous Thromboembolism* / epidemiology
  • Venous Thromboembolism* / virology

Substances

  • Anticoagulants
  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2