Thromboprophylaxis: balancing evidence and experience during the COVID-19 pandemic
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Thromboprophylaxis: balancing evidence and experience during the COVID‑19 pandemic Benjamin Marchandot1 · Antonin Trimaille1 · Anais Curtiaud1 · Kensuke Matsushita1,2 · Laurence Jesel1,2 · Olivier Morel1,2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract A common and potent consideration has recently entered the landscape of the novel coronavirus disease of 2019 (COVID-19): venous thromboembolism (VTE). COVID-19 has been associated to a distinctive related coagulopathy that shows unique characteristics. The research community has risen to the challenges posed by this « evolving COVID-19 coagulopathy » and has made unprecedented efforts to promptly address its distinct characteristics. In such difficult time, both national and international societies of thrombosis and hemostasis released prompt and timely responses to guide recognition and management of COVID-19-related coagulopathy. However, latest guidelines released by the international Society on Thrombosis and Haemostasis (ISTH) on May 27, 2020, followed the American College of Chest Physicians (CHEST) on June 2, 2020 showed some discrepancies regarding thromboprophylaxis use. In this forum article, we would like to offer an updated focus on thromboprophylaxis with current incidence of VTE in ICU and non-ICU patients according to recent published studies; highlight the main differences regarding ISTH and CHEST guidelines; summarize and describe which are the key ongoing RCTs testing different anticoagulation strategies in patients with COVID-19; and finally set a proposal for COVID-19 coagulopathy specific risk factors and dedicated trials. Keywords COVID-19 · Coronavirus · Thromboprophylaxis · Venous thromboembolism · Guidelines Abbreviations CA Chronic therapeutic anticoagulation BID Twice-daily BMI Body mass index COVID-19 Coronavirus disease 2019 CT Computed tomography DOAC Direct oral anticoagulant DVT Deep vein thrombosis ICU Intensive care unit IT Thromboprophylaxis with intermediate dose of LMWH/ UFH LMWH Low molecular weight heparin N/A Not available
PE Pulmonary embolism RCTs Randomized controlled trials SD Routine thromboprophylaxis with standard dose of UFH or LMWH TD Thromboprophylaxis with therapeutic dose UFH Unfractionated heparin VTE Venous thromboembolism Highlights • Reported incidence of venous thrombotic events in
COVID-19 patients
• Major differences between ISTH and CHEST guidelines
in thromboprophylaxis for patients with COVID-19
* Olivier Morel olivier.morel@chru‑strasbourg.fr 1
Division of Cardiovascular Medicine, Nouvel Hôpital Civil, Strasbourg University Hospital, 1 place de l’Hôpital, 67000 Strasbourg, France
INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, FMTS, 67000 Strasbourg, France
2
• Ongoing RCTs of different anticoagulation strategies in
patients with COVID-19
• A proposal for COVID-19 coagulopathy specific risk fac-
tors and dedicated trials
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