Thromboprophylaxis: balancing evidence and experience during the COVID-19 pandemic

• Published in: Journal of thrombosis and thrombolysis 2020-11, Vol.50 (4), p.799-808
• Main Authors: Marchandot, Benjamin, Trimaille, Antonin, Curtiaud, Anais, Matsushita, Kensuke, Jesel, Laurence, Morel, Olivier
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Betacoronavirus - pathogenicity; Blood Coagulation - drug effects; Cardiology; Chest; Clinical trials; Coronavirus Infections - blood; Coronavirus Infections - epidemiology; Coronavirus Infections - therapy; Coronavirus Infections - virology; Coronaviruses; COVID-19; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - adverse effects; Hematology; Hemostasis; Host-Pathogen Interactions; Human health and pathology; Humans; Life Sciences; Male; Medicine; Medicine & Public Health; Middle Aged; Pandemics; Pneumonia, Viral - blood; Pneumonia, Viral - epidemiology; Pneumonia, Viral - therapy; Pneumonia, Viral - virology; Risk Factors; SARS-CoV-2; Thromboembolism; Thromboembolism - blood; Thromboembolism - epidemiology; Thromboembolism - prevention & control; Thromboembolism - virology; Thrombosis; Treatment Outcome
• ISSN: 0929-5305; 1573-742X; 1573-742X
• DOI: 10.1007/s11239-020-02231-3

A common and potent consideration has recently entered the landscape of the novel coronavirus disease of 2019 (COVID-19): venous thromboembolism (VTE). COVID-19 has been associated to a distinctive related coagulopathy that shows unique characteristics. The research community has risen to the challenges posed by this « evolving COVID-19 coagulopathy » and has made unprecedented efforts to promptly address its distinct characteristics. In such difficult time, both national and international societies of thrombosis and hemostasis released prompt and timely responses to guide recognition and management of COVID-19-related coagulopathy. However, latest guidelines released by the international Society on Thrombosis and Haemostasis (ISTH) on May 27, 2020, followed the American College of Chest Physicians (CHEST) on June 2, 2020 showed some discrepancies regarding thromboprophylaxis use. In this forum article, we would like to offer an updated focus on thromboprophylaxis with current incidence of VTE in ICU and non-ICU patients according to recent published studies; highlight the main differences regarding ISTH and CHEST guidelines; summarize and describe which are the key ongoing RCTs testing different anticoagulation strategies in patients with COVID-19; and finally set a proposal for COVID-19 coagulopathy specific risk factors and dedicated trials.