Resource: Antithrombotic Therapy in Patients with COVID-19
Source: National Institutes of Health (NIH)
Synopsis: The above reference is a summary of recommendations from the NIH (last updated 12/17/20) for deep venous thrombosis (DVT) and venous thromboembolism (VTE) screening, prophylaxis, and treatment for both hospitalized and ambulatory patients with COVID-19. Many of the recommendations are for adults but there are also specific recommendations and precautions for pregnant and lactating women as well as children with COVID-19.
This information is important as there is a well-documented association between COVID-19 and DVT/VTE. Specifically, the prevalence of VTE in hospitalized COVID-19 patients is between 14-40%. While the prevalence of VTE is high in this population, we must remember that the prevalence of non-COVID-19 hospitalized patients who received VTE prophylactic anticoagulation was 5-16% for all patients and up to 37% in critically ill patients. Many of the recommendations for COVID-19 patients come from previous studies of hospitalized non-COVID-19 patients. The article synthesizes available COVID-19 data and the aforementioned non-COVID-19 data and offers recommendations. Below is a condensed list. For a complete list, please refer to the hyperlink above.
Screening:
- There is no evidence to support routine DVT/VTE ultrasound screening in patients with COVID-19 at this time. In contrast, hospitalized COVID-19 patients who are deteriorating, DVT/VTE should be suspected and worked-up accordingly.
- Nonhospitalized patients should not be routinely tested for markers of coagulopathy while there is no evidence for or against hematologic testing while hospitalized for COVID-19.
Prophylaxis:
- Hospitalized non-pregnant COVID-19 patients should be given standard VTE prophylactic doses while in the hospital unless contraindicated.
- Discharged patients should not be routinely continued on VTE prophylaxis.
Treatment:
- There is insufficient data either for or against the use of therapeutic or higher than prophylactic doses of anticoagulation for VTE for hospitalized COVID-19 patients.
- COVID-19 patients who are on chronic anticoagulation and antiplatelet medications should stay on their therapies.
Children:
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Indications for VTE prophylaxis in hospitalized children with COVID-19 should be the same as those without COVID-19.
Pregnant and Lactating women:
- If hospitalized, pregnant and lactating women should be given prophylactic anticoagulation if not contraindicated.
- If anticoagulation therapy is prescribed during pregnancy prior to a COVID-19 diagnosis, it should be continued.
Comment: COVID-19 has been associated with a prothrombotic state with high rates of DVT/VTE. This article offers recommendations for prophylaxis, screening, or treatment of COVID-19 positive patients of different demographic groups. Based on current data available, treatment should generally follow our treatment algorithms for non-COVID-19 hospitalized patients. That being said, hospitalized COVID-19 patients who are deteriorating should be suspected and worked-up for DVT/VTE given their risk profile.
