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Considerations for Perioperative Thromboembolic Risk Mitigation in Actively and Recently COVID-19-Positive Patients
Gianna Guarino1, Nicole Sgromolo1, Aviram M Giladi1
1The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
Insights
Patients with Coronavirus Disease 2019 (COVID) face increased thrombosis risks during hand surgery. This review guides hand surgeons in managing these patients, focusing on preoperative, intraoperative, and postoperative care to mitigate thrombotic events.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Orthopedic Surgery
Background:
- Coronavirus Disease 2019 (COVID) is associated with a hypercoagulable state, increasing risks of venous and arterial thromboses.
- Distal limb and microvascular circulation are vital for successful hand surgery outcomes.
- Patients with active or recent COVID infections may have elevated perioperative thrombotic event risks.
Purpose of the Study:
- To review existing literature on managing hand surgery patients with active or recent COVID-19 infection.
- To provide guidance for hand surgeons on preoperative risk assessment, intraoperative decision-making, and postoperative care for these patients.
- To address the limited information available on handling COVID-positive patients in hand surgery settings.
Main Methods:
- Literature review of studies concerning COVID-19, hypercoagulability, and surgical management.
- Analysis of perioperative thrombotic risks in the context of hand surgery.
- Synthesis of findings to develop recommendations for clinical practice.
Main Results:
- COVID-19 significantly elevates thrombotic risks, particularly impacting microvascular circulation crucial for hand surgery.
- Specific protocols for preoperative evaluation, intraoperative monitoring, and postoperative management are needed for COVID-positive patients.
- Current literature offers limited direct guidance, necessitating a proactive approach by hand surgeons.
Conclusions:
- Hand surgeons must be prepared to manage increased thrombotic risks in patients with active or recent COVID-19.
- A comprehensive strategy encompassing risk assessment, surgical planning, and vigilant postoperative care is essential.
- Further research is warranted to establish definitive guidelines for managing COVID-19 patients undergoing hand surgery.
Abstract:
Coronavirus Disease 2019 (COVID) induces a hypercoagulable state causing an increased risk of venous and arterial thromboses. Distal limb and microvascular circulation are critical to the success of many hand surgeries, and patients who are actively or recently infected with COVID may be at a higher risk for perioperative thrombotic events. Little information is available regarding how to handle actively or recently infected COVID patients, including preoperative risk assessment, intraoperative decision making, and postoperative considerations regarding thrombotic risk. Our aim was to review the literature to determine how the hand surgeon can best prepare for and manage the actively or recently COVID-positive patients undergoing hand surgeries.
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