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 management of these medications can be difficult in potentially critically ill patients.In this paper, we review the current guidelines, consensus statements, and emerging evidence for a wide range of cardiovascular disease states with special focus on anticoagulant and antiplatelet therapy. Our goal is to provide guidance for treatment of the cardiovascular patient with COVID-19 in the face of a rapidly evolving understanding of this virus and its complications.Preamble:Anticoagulant and antiplatelet therapies are a major cause of inpatient morbidity and mortality. This is amplified in critically ill patients. COVID-19 patients present special challenges due to rapidly changing clinical status. 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. Our deliberations and treatment recommendations are summarized here.Objective:To provide guidance to the utilization of antithrombotic and antiplatelet therapies in patients with known or suspected COVID-19.
Keywords: Acute coronary syndrome; Anti-coagulation; Anti-platelet; COVID-19; Extracorporeal membrane oxygenation; Left Ventricular Assist Device; Peripheral Arterial Disease; Stroke; Thrombosis; Venous Thromboembolism.
COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up.J Am Coll Cardiol. 2020 Apr 15:S0735-1097(20)35008-7. doi: 10.1016/j.jacc.2020.04.031. Online ahead of print. J Am Coll Cardiol. 2020. PMID: 32311448 Free PMC article. Review.
[Recommendations on antithrombotic treatment during the COVID-19 pandemic. Position statement of the Working Group on Cardiovascular Thrombosis of the Spanish Society of Cardiology].Rev Esp Cardiol. 2020 Apr 22. doi: 10.1016/j.recesp.2020.04.006. Online ahead of print. Rev Esp Cardiol. 2020. PMID: 32327870 Free PMC article. Spanish.
Venous Thromboembolism Complicated with COVID-19: What Do We Know So Far?Acta Haematol. 2020 May 12:1-8. doi: 10.1159/000508233. Online ahead of print. Acta Haematol. 2020. PMID: 32396903 Review.
Expanded Umbilical Cord Mesenchymal Stem Cells (UC-MSCs) as a Therapeutic Strategy in Managing Critically Ill COVID-19 Patients: The Case for Compassionate Use.Pain Physician. 2020 Mar;23(2):E71-E83. Pain Physician. 2020. PMID: 32214286
Scientific and Standardization Committee Communication: Clinical Guidance on the Diagnosis, Prevention and Treatment of Venous Thromboembolism in Hospitalized Patients with COVID-19.J Thromb Haemost. 2020 May 27. doi: 10.1111/jth.14929. Online ahead of print. J Thromb Haemost. 2020. PMID: 32459046