Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Jul;162(1):213-225.
doi: 10.1016/j.chest.2022.02.006. Epub 2022 Feb 12.

Thromboprophylaxis in Patients With COVID-19: A Brief Update to the CHEST Guideline and Expert Panel Report

Lisa K Moores  1 , Tobias Tritschler  2 , Shari Brosnahan  3 , Marc Carrier  4 , Jacob F Collen  5 , Kevin Doerschug  6 , Aaron B Holley  7 , Jonathan Iaccarino  8 , David Jimenez  9 , Gregoire LeGal  4 , Parth Rali  10 , Philip Wells  4
Affiliations
Meta-Analysis

Thromboprophylaxis in Patients With COVID-19: A Brief Update to the CHEST Guideline and Expert Panel Report

Lisa K Moores et al. Chest. 2022 Jul.

Erratum in

Abstract

Background: Patients hospitalized with COVID-19 often exhibit markers of a hypercoagulable state and have an increased incidence of VTE. In response, CHEST issued rapid clinical guidance regarding prevention of VTE. Over the past 18 months the quality of the evidence has improved. We thus sought to incorporate this evidence and update our recommendations as necessary.

Study design and methods: This update focuses on the optimal approach to thromboprophylaxis in hospitalized patients. The original questions were used to guide the search, using MEDLINE via PubMed. Eight randomized controlled trials and one observational study were included. Meta-analysis, using a random effects model, was performed. The panel created summaries using the GRADE Evidence-to-Decision framework. Updated guidance statements were drafted, and a modified Delphi approach was used to obtain consensus.

Results: We provide separate guidance statements for VTE prevention for hospitalized patients with acute (moderate) illness and critically ill patients in the ICU. However, we divided each original question and resulting recommendation into two questions: standard prophylaxis vs therapeutic (or escalated dose) prophylaxis and standard prophylaxis vs intermediate dose prophylaxis. This led to a change in one recommendation, and an upgrading of three additional recommendations based upon higher quality evidence.

Conclusions: Advances in care for patients with COVID-19 have improved overall outcomes. Despite this, rates of VTE in these patients remain elevated. Critically ill patients should receive standard thromboprophylaxis for VTE, and moderately ill patients with a low bleeding risk might benefit from therapeutic heparin. We see no role for intermediate dose thromboprophylaxis in either setting.

Keywords: COVID-19; DIC; DVT; VTE; hypercoagulability; pulmonary embolism.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Outcomes in moderately ill hospitalized patients receiving therapeutic anticoagulation vs standard thromboprophylaxis.
Figure 2
Figure 2
Outcomes in critically ill patients receiving increased-dose anticoagulation vs standard thromboprophylaxis. PPx = prophylaxis or thromboprophylaxis.
Figure 3
Figure 3
Outcomes in critically ill patients receiving intermediate-dose thromboprophylaxis vs standard thromboprophylaxis.
See this image and copyright information in PMC

Comment in

  • Thromboprophylaxis Strategies for Hospitalized Patients With COVID-19.
    Porres-Aguilar M, Mukherjee D, Lazo-Langner A. Porres-Aguilar M, et al. Chest. 2022 Jul;162(1):e69-e70. doi: 10.1016/j.chest.2022.03.038. Chest. 2022. PMID: 35809961 Free PMC article. No abstract available.
  • Response.
    Moores LK, Tritschler T, Le Gal G, Carrier M. Moores LK, et al. Chest. 2022 Jul;162(1):e70-e71. doi: 10.1016/j.chest.2022.03.037. Chest. 2022. PMID: 35809962 Free PMC article. No abstract available.

References

    1. Tang N., Bai H., Chen X., Gong J., Li D., Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18(5):1094–1099. - PMC - PubMed
    1. Tang N., Pan Y., Xu C., Li D. Characteristics of emergency patients with markedly elevated D-dimer levels. Sci Rep. 2020;10(1):7784. - PMC - PubMed
    1. Moores L.K., Tritschler T., Brosnahan S., et al. Prevention, diagnosis, and treatment of VTE in patients with coronavirus disease 2019: CHEST Guideline and Expert Panel Report. Chest. 2020;158(3):1143–1163. - PMC - PubMed
    1. NICE COVID-19 management. 2021. https://www.guidelines.co.uk/infection/nice-covid-19-management/455939.a...
    1. COVID-19 clinical management: living guidance. World Health Organization; 2021. https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-1

MeSH terms