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. 2020 Jan-Dec:26:1076029620936350.
doi: 10.1177/1076029620936350.

Evidence-Based Practical Guidance for the Antithrombotic Management in Patients With Coronavirus Disease (COVID-19) in 2020

Eduardo Ramacciotti  1   2   3 , Ariane Scarlatelli Macedo  2 , Rodrigo Bruno Biagioni  4 , Roberto Augusto Caffaro  2 , Renato Delascio Lopes  5 , João Carlos Guerra  6   7 , Fernanda Andrade Orsi  8 , Marcos Areas Marques  9 , Alfonso J Tafur  10 , Joseph A Caprini  10 , Andrew Nicolaides  11 , Charles A Carter  12 , Cyrillo Carvalheiro Filho  13   14 , Jawed Fareed  3
Affiliations

Evidence-Based Practical Guidance for the Antithrombotic Management in Patients With Coronavirus Disease (COVID-19) in 2020

Eduardo Ramacciotti et al. Clin Appl Thromb Hemost. 2020 Jan-Dec.

Abstract

This practical guidance, endorsed by the Brazilian Society of Thrombosis and Hemostasis and The Brazilian Society of Angiology and Vascular Surgery, the International Union of Angiology and the European Venous Forum, aims to provide physicians with clear guidance, based on current best evidence-based data, on clinical strategies to manage antithrombotic strategies in patients with coronavirus disease 2019.

Keywords: SARS-CoV-2; anticoagulants; antiplatelets; antithrombotic therapy; coronavirus disease 2019; thrombosis.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Coronavirus disease 2019 and thrombotic risk mechanism. Severe acute respiratory-CoV-2 direct pulmonary and systemic infection, due to its endothelial invasion and dysfunction, activates an inflammatory response, leading to the release of inflammatory mediators. Endothelial and hemostatic activation ensues, with decreased levels of tissue factor pathway inhibitor (TFPI) and increased tissue factor. This viral infection inflammation/coagulation interplay, in association with stasis, cardiovascular diseases, and genetics, leverages the hemostatic derangement , It results in venous thromboembolism (VTE), particularly pulmonary embolism (PE), arterial thrombosis, myocardial infarction (MI), strokes, and cardiovascular death. In case of further hemostatic derangement; disseminated intravascular coagulation (DIC), whose treatment is different from PE.
Figure 2.
Figure 2.
Epidemiology. Very high incidence of thrombotic COVID-associated events. The most updated epidemiology data comes from Klok and colleagues, that reevaluated their initial findings and reported a follow-up from 7 to 14 days on 184 intensive care unit (ICU) patients of whom a total of 41 died (22%) and 78 were discharged alive (43%). All patients received pharmacological thromboprophylaxis. The cumulative incidence of the composite outcome, adjusted for competing for risk of death, was 49% (95% CI: 41% to 57%). The majority of thrombotic events were pulmonary embolism (PE; 65/75; 87%). Patients diagnosed with thrombotic complications were at higher risk of all-cause death (hazard ratio [HR]: 5.4; 95% CI: 2.4 to 12). Use of therapeutic anticoagulation was not associated with all-cause death (HR: 0.79, 95% CI: 0.35-1.8).
Figure 3.
Figure 3.
Heparins–in hospital prophylaxis doses of anticoagulants for coronavirus disease 2019 (COVID-19) patients.
Figure 4.
Figure 4.
Extended venous thromboembolism (VTE) prophylaxis strategy doses.
Figure 5.
Figure 5.
Heparins–VTE treatment doses. Inhospital full anticoagulation doses of parenteral drugs for coronavirus disease 2019 (COVID-19) patients.
Figure 6.
Figure 6.
Direct oral anticoagulants anticoagulation doses for coronavirus disease 2019 (COVID-19) patients.
See this image and copyright information in PMC

References

    1. Clerkin KJ, Fried JA, Raikhelkar J, et al. Coronavirus disease 2019 (COVID-19) and cardiovascular disease. Circulation. 2020;141(20):1648–1655. - PubMed
    1. Engelmann B, Massberg S. Thrombosis as an intravascular effector of innate immunity. Nat Rev Immunol. 2013;13(1):34–45. - PubMed
    1. Gupta AK, Jneid H, Addison D, et al. Current perspectives on coronavirus 2019 (COVID-19) and cardiovascular disease: a white paper by the JAHA editors. J Am Heart Assoc. 2020;9:e017013. - PMC - PubMed
    1. Ramacciotti E, Agati LB, Aguiar VCR, et al. Zika and Chikungunya virus and risk for venous thromboembolism. Clin Appl Thromb Hemost. 2019;25:1076029618821184. - PMC - PubMed
    1. Ramacciotti E, Blackburn S, Hawley AE, et al. Evaluation of soluble P-selectin as a marker for the diagnosis of deep venous thrombosis. Clin Appl Thromb Hemost. 2011;17(4):425–431. - PMC - PubMed

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