Diagnosis, management, and outcomes of venous thromboembolism in COVID-19 positive patients: a role for direct anticoagu
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Diagnosis, management, and outcomes of venous thromboembolism in COVID‑19 positive patients: a role for direct anticoagulants? Charalampos Kartsios1 · Anand Lokare1 · Husam Osman2 · Damian Perrin3 · Shahzad Razaq4 · Namrah Ayub4 · Bobby Daddar4 · Susan Fair3
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Coronavirus disease 2019 (COVID-19) has been associated with an increased risk of thromboembolic complications due to systemic coagulation activation. Little is known about the role of direct anticoagulants (DOACs) in COVID-19 related thrombosis. In this audit we sought to distinguish COVID-19 hospitalised patients with a diagnosis of venous thromboembolism (VTE) and record their outcomes over a period of 3 months (01/02/2020–30/04/2020). A total of 1583 patients were diagnosed with laboratory proven COVID-19 disease. Amongst them, 38 patients (0.82%) suffered VTE (median age 68 years, male/female: 20/18). VTE was the presenting symptom on admission in 71%. Pulmonary embolism was diagnosed in 92% of patients; 5 patients required intensive care and 3 underwent thrombolysis. 27 patients received initial treatment with unfractionated heparin/low molecular weight heparin (LMWH) while 10 were treated with direct anticoagulants (DOACs). After a median follow up of 25 days, 29 (76%) patients were alive while 5 were still hospitalised. Most patients (83%) were discharged on DOACs, no VTE recurrence or bleeding was recorded post-discharge. Our results suggest that direct anticoagulants could be a safe and effective treatment option in selected COVID-19 positive patients who have suffered venous thromboembolism. Keywords COVID-19 · Direct anticoagulants · Venous thromboembolism · Heparin · D-dimers
Highlights • COVID-19 has been associated with an increased risk of
thromboembolic complications, mainly in the intensive care setting. • 38 consecutive patients with COVID-19 and venous thromboembolism (VTE) and their subsequent management, are described. Most patients (33/38) were treated on general wards. * Charalampos Kartsios [email protected] 1
Department of Haematology, Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
2
Department of Virology, Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
3
Department of Acute Medicine, Good Hope Hospital, University Hospitals Birmingham, Birmingham, UK
4
Department of Pharmacy, University Hospitals Birmingham, Birmingham, UK
• Treatment with direct oral anticoagulants (DOACs) upon
VTE diagnosis, appears effective in selected COVID-19 patients. • Most patients (83%) were discharged on DOACs without any complications. • DOACs could be considered in the design of prospective clinical trials focusing on COVID-19 related VTE.
Introduction Coronavirus disease 2019 (COVID-19), a viral respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the biggest pandemic in the last 100 years. It has resulted so far in more than five million confirmed ca
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