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COVID-Inflicted Coagulopathy: Expert Consensus on Management with Novel Oral Anticoagulants in India

H K Chopra1, Tiny Nair2, C K Ponde3

  • 1Senior Consultant Cardiologist, Medanta: Moolchand Heart Institute, New Delhi.

The Journal of the Association of Physicians of India
|January 21, 2022
PubMed

Insights

Novel oral anticoagulants (NOACs) may be a practical choice for managing COVID-19-inflicted coagulopathy (CIC) in India, especially in home settings. Consensus is needed due to challenges with traditional treatments like low molecular weight heparin (LMWH).

Area of Science:

  • Internal Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Coronavirus disease 2019 (COVID-19) presents a significant risk of hypercoagulability, termed COVID-inflicted coagulopathy (CIC), leading to increased morbidity and mortality.
  • International guidelines recommend low molecular weight heparin (LMWH) for CIC management in both hospital and home settings.
  • Subcutaneous LMWH administration poses challenges for widespread home-based treatment in India due to feasibility issues.

Purpose of the Study:

  • To address the need for a consensus on the use of novel oral anticoagulants (NOACs) for managing COVID-inflicted coagulopathy (CIC) in India.
  • To explore the role of NOACs in home-based COVID-19 management, considering resource limitations.
  • To evaluate the practicality of NOACs compared to LMWH in the Indian context.

Main Methods:

  • Review of existing literature and guidelines on anticoagulation for COVID-19.
  • Analysis of the feasibility and adherence challenges associated with LMWH in home settings in India.
  • Consideration of the increasing use of NOACs for home-based COVID-19 treatment during the pandemic.

Main Results:

  • Low molecular weight heparin (LMWH) may not be universally feasible for home management of COVID-19-inflicted coagulopathy (CIC) in India.
  • Novel oral anticoagulants (NOACs) have been increasingly prescribed for home-based COVID-19 care due to ease of administration and adherence.
  • Current guidelines often do not recommend NOACs in hospitalized settings, creating a gap in evidence for home use.

Conclusions:

  • A consensus is required regarding the use of NOACs for managing COVID-inflicted coagulopathy (CIC) in India.
  • The practical challenges of LMWH necessitate exploring alternative anticoagulation strategies like NOACs for home care.
  • Further research and guideline development are needed to support the appropriate use of NOACs in managing CIC in resource-constrained settings.

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