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Review
. 2022 Oct 11;11(20):5997.
doi: 10.3390/jcm11205997.

Practical Recommendations for Optimal Thromboprophylaxis in Patients with COVID-19: A Consensus Statement Based on Available Clinical Trials

Konstantinos G Kyriakoulis  1 , Evangelos Dimakakos  1 , Ioannis G Kyriakoulis  1 , Mariella Catalano  2 , Alex C Spyropoulos  3   4 , Sam Schulman  5 , James Douketis  6 , Anna Falanga  7   8 , Anthony Maraveyas  9 , Dan-Mircea Olinic  10 , Jill Belch  11 , Grigorios Gerotziafas  12   13 , Konstantinos Syrigos  1 , Anastasios Kollias  1 ; COVID-19 Thrombosis Collaborative Group, Endorsed by VAS-European Independent Foundation in Angiology/Vascular Medicine, UEMS Division of Angiology/Vascular Medicine/and ESVM-European Society of Vascular Medicine and Supported by the Balkan Working Group
Collaborators, Affiliations
Review

Practical Recommendations for Optimal Thromboprophylaxis in Patients with COVID-19: A Consensus Statement Based on Available Clinical Trials

Konstantinos G Kyriakoulis et al. J Clin Med. .

Abstract

Coronavirus disease 2019 (COVID-19) has been shown to be strongly associated with increased risk for venous thromboembolism events (VTE) mainly in the inpatient but also in the outpatient setting. Pharmacologic thromboprophylaxis has been shown to offer significant benefits in terms of reducing not only VTE events but also mortality, especially in acutely ill patients with COVID-19. Although the main source of evidence is derived from observational studies with several limitations, thromboprophylaxis is currently recommended for all hospitalized patients with acceptable bleeding risk by all national and international guidelines. Recently, high quality data from randomized controlled trials (RCTs) further support the role of thromboprophylaxis and provide insights into the optimal thromboprophylaxis strategy. The aim of this statement is to systematically review all the available evidence derived from RCTs regarding thromboprophylaxis strategies in patients with COVID-19 in different settings (either inpatient or outpatient) and provide evidence-based guidance to practical questions in everyday clinical practice. Clinical questions accompanied by practical recommendations are provided based on data derived from 20 RCTs that were identified and included in the present study. Overall, the main conclusions are: (i) thromboprophylaxis should be administered in all hospitalized patients with COVID-19, (ii) an optimal dose of inpatient thromboprophylaxis is dependent upon the severity of COVID-19, (iii) thromboprophylaxis should be administered on an individualized basis in post-discharge patients with COVID-19 with high thrombotic risk, and (iv) thromboprophylaxis should not be routinely administered in outpatients. Changes regarding the dominant SARS-CoV-2 variants, the wide immunization status (increasing rates of vaccination and reinfections), and the availability of antiviral therapies and monoclonal antibodies might affect the characteristics of patients with COVID-19; thus, future studies will inform us about the thrombotic risk and the optimal therapeutic strategies for these patients.

Keywords: COVID-19; COVID-19 therapeutics; anticoagulation; dosage; mortality; thromboprophylaxis; treatment.

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Conflict of interest statement

A.C.S. has served as a consultant for Janssen, Bristol Meyer Squibb, Sanofi, Boehringer Ingelheim, and ATLAS Group, and has received research support by Janssen, Boehringer Ingelheim; J.D. has received research support from CIHR and HSFC, royalties form Up-to-Date and Merck Manual, consulting fees from Janssen, Servier and PhaseBio, and honoraria from Pfizer, Leo Pharma and Sanofi. Conflicts of interest for authors of the COVID-19 Thrombosis Collaborative Group are declared after the References section at the end of the manuscript; none for the other authors.

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