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Thromboembolic risk and anticoagulant therapy in COVID-19 patients: emerging evidence and call for action

Anastasios Kollias1, Konstantinos G Kyriakoulis1, Evangelos Dimakakos1

  • 1Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Greece.

British Journal of Haematology
|April 19, 2020
PubMed

Insights

Severe COVID-19 patients face high risks of blood clots, particularly venous thromboembolism. Early D-dimer testing and anticoagulant therapy may improve outcomes for high-risk individuals.

Area of Science:

  • Critical Care Medicine
  • Hematology
  • Infectious Diseases

Background:

  • Severe COVID-19 is linked to coagulopathy, specifically disseminated intravascular coagulation, increasing venous thromboembolism (VTE) risk.
  • VTE incidence in intensive care unit (ICU) COVID-19 patients may exceed that in other critical conditions.
  • D-dimer levels can aid in identifying high-risk COVID-19 patients and predicting prognosis.

Purpose of the Study:

  • To review the coagulopathic complications of COVID-19.
  • To highlight the role of D-dimer in risk stratification.
  • To discuss the implications of anticoagulant therapy in severe COVID-19.

Main Methods:

  • Review of emerging evidence on COVID-19 associated coagulopathy.
  • Analysis of D-dimer as a predictive biomarker.
  • Evaluation of preliminary data on anticoagulant therapy efficacy.

Main Results:

  • COVID-19 patients, especially in ICUs, exhibit a high prothrombotic state and VTE risk.
  • Elevated D-dimer levels are associated with increased VTE risk and poorer outcomes.
  • Anticoagulant therapy in severe COVID-19, particularly with sepsis-induced coagulopathy or high D-dimer, correlates with reduced mortality.

Conclusions:

  • Hospitalized COVID-19 patients warrant thromboprophylaxis.
  • Full anticoagulation should be considered for patients with indications like sepsis-induced coagulopathy or markedly elevated D-dimer.
  • Vigilant monitoring and management of coagulopathy are crucial in severe COVID-19 care.

Keywords:
SARS-CoV-2anticoagulantprophylaxisthromboembolismthrombosis

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