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. 2020 May 21;1-10.
doi: 10.1007/s11239-020-02138-z. Online ahead of print.

Thromboembolism and Anticoagulant Therapy During the COVID-19 Pandemic: Interim Clinical Guidance From the Anticoagulation Forum

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Free PMC article

Thromboembolism and Anticoagulant Therapy During the COVID-19 Pandemic: Interim Clinical Guidance From the Anticoagulation Forum

Geoffrey D Barnes et al. J Thromb Thrombolysis. .
Free PMC article

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.

Keywords: Anticoagulation; COVID-19; Direct oral anticoagulant; Prophylaxis; Stewardship; Venous thromboembolism.

Conflict of interest statement

Marilyn Blumenstein, Allison Burnett, Nathan P Clark, William E Dager, Stacy Ellsworth, David Garcia and Tracy Minichiello have no disclosures to declare. Arthur Allen has received consulting fees from Boehringer-Ingelheim, Bristol-Myers Squibb/Pfizer, Janssen Pharmaceuticals, Portola Pharmaceuticals, and Roche Diagnostics. Geoffrey D Barnes has received grant funding from Bristol-Myers Squibb/Pfizer, National Heart, Lung, and Blood Institute, and Blue Cross Blue Shield of Michigan and has received consulting fees from Bristol-Myers Squibb/Pfizer, Janssen Pharmaceuticals, Portola Pharmaceuticals, and AMAG Pharmaceuticals. Adam Cuker has received consulting fees from Synergy and his institution has received research support on his behalf from Alexion, Bayer, Novo Nordisk, Pfizer, Sanofi, Spark, and Takeda. Steven B Deitelzweig has received consulting fees from Bristol-Myers Squibb, Novosys, Optum Insight, Pfizer, and Portola Pharmaceuticals. Scott Kaatz has received research funding from Janssen Pharmaceuticals and consulting fees from Janssen Pharmaceuticals, Bristol-Myers Squibb/Pfizer, Portola Pharmaceuticals, and Roche Diagnostics.

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