COVID-19 coagulopathy and thrombosis: Analysis of hospital protocols in response to the rapidly evolving pandemic

Thromb Res. 2020 Dec;196:355-358. doi: 10.1016/j.thromres.2020.09.018. Epub 2020 Sep 16.

Abstract

As the Coronavirus disease 2019 (COVID-19) pandemic spread to the US, so too did descriptions of an associated coagulopathy and thrombotic complications. Hospitals created institutional protocols for inpatient management of COVID-19 coagulopathy and thrombosis in response to this developing data. We collected and analyzed protocols from 21 US academic medical centers developed between January and May 2020. We found greatest consensus on recommendations for heparin-based pharmacologic venous thromboembolism (VTE) prophylaxis in COVID-19 patients without contraindications. Protocols differed regarding incorporation of D-dimer tests, dosing of VTE prophylaxis, indications for post-discharge pharmacologic VTE prophylaxis, how to evaluate for VTE, and the use of empiric therapeutic anticoagulation. These findings support ongoing efforts to establish international, evidence-based guidelines.

Keywords: Anticoagulation; Coagulopathy; Coronavirus; Deep vein thrombosis (DVT); Pulmonary embolism (PE); Thrombosis; Venous thromboembolism (VTE).

Publication types

  • Letter

MeSH terms

  • Academic Medical Centers
  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects
  • Blood Coagulation / drug effects*
  • COVID-19 / blood
  • COVID-19 / complications
  • COVID-19 / diagnosis
  • COVID-19 / drug therapy*
  • Clinical Protocols*
  • Consensus
  • Healthcare Disparities / trends
  • Humans
  • Practice Patterns, Physicians' / trends
  • Pulmonary Embolism / blood
  • Pulmonary Embolism / diagnosis
  • Pulmonary Embolism / etiology
  • Pulmonary Embolism / prevention & control*
  • Risk Assessment
  • Risk Factors
  • Thrombophilia / blood
  • Thrombophilia / diagnosis
  • Thrombophilia / etiology
  • Thrombophilia / prevention & control*
  • Treatment Outcome
  • United States
  • Venous Thromboembolism / blood
  • Venous Thromboembolism / diagnosis
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / prevention & control*
  • Venous Thrombosis / blood
  • Venous Thrombosis / diagnosis
  • Venous Thrombosis / etiology
  • Venous Thrombosis / prevention & control*

Substances

  • Anticoagulants