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PICO Questions and DELPHI Methodology for the Management of Venous Thromboembolism Associated with COVID-19

Antoni Riera-Mestre1,2, Luis Jara-Palomares3,4, Ramón Lecumberri5,6

  • 1Internal Medicine Department, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain.

Viruses
|November 27, 2021
PubMed

Insights

COVID-19 patients face increased venous thromboembolic disease (VTE) risk. Experts recommend specific anticoagulation strategies, including LMWH for hospitalized patients and avoiding routine D-dimer testing, to manage VTE in COVID-19.

Area of Science:

  • Internal Medicine
  • Hematology
  • Infectious Diseases

Background:

  • Patients with coronavirus disease 2019 (COVID-19) exhibit a heightened risk of venous thromboembolic disease (VTE), encompassing both macrothrombosis and microthrombosis, compared to individuals with other inflammatory conditions.
  • The optimal use of anticoagulation in COVID-19 patients remains a subject of ongoing debate and clinical uncertainty.

Purpose of the Study:

  • To establish a consensus among multidisciplinary experts on anticoagulation management for patients with COVID-19.
  • To address key clinical questions regarding thromboprophylaxis and treatment using the PICO (Population, Intervention, Comparison, Outcome) framework.

Main Methods:

  • The study employed the DELPHI methodology, a structured process for achieving consensus among a panel of experts.
  • Seven PICO questions were formulated and addressed by a multidisciplinary group of venous thromboembolic disease (VTE) experts.

Main Results:

  • Consensus was reached on several recommendations, including avoiding pharmacological thromboprophylaxis for most non-hospitalized COVID-19 patients.
  • For hospitalized patients, recommendations include replacing oral anticoagulants with therapeutic-dose low molecular weight heparin (LMWH), standard-dose LMWH for ward patients, and intensive care unit (ICU) patients.
  • Routine D-dimer testing for VTE diagnosis or risk stratification in hospitalized COVID-19 patients is not recommended; thromboprophylaxis should generally be discontinued upon discharge, with anticoagulant treatment withdrawn after 3 months for associated VTE events.

Conclusions:

  • The DELPHI methodology successfully generated expert consensus on critical anticoagulation strategies for COVID-19 patients.
  • These evidence-based recommendations provide guidance for managing VTE risk and treatment in the context of COVID-19.
  • The findings aim to standardize and optimize anticoagulation care for COVID-19 patients, addressing a significant clinical challenge.

Keywords:
COVID-19anticoagulationcoronavirusdeep vein thrombosispulmonary embolismvenous thromboembolic disease

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