Management principles of patients with venous thromboembolism during the COVID-19 pandemic

Abstract

The spread of the new SARS-CoV-2 infection, now classified as COVID-19, has become global. The physician who treat patients with COVID-19 face daily new serious problems. One of them is a high prevalence of venous thromboembolic complications, especially in the group of patients with a severe course of the infectious process. Current recommendations allow an empirical approach to prescribing anticoagulation in the case of a reasonable suspicion on the pulmonary embolism/deep vein thrombosis, if the assumed waiting period for visualization is >4/24 hours, respectively. The use of prophylactic doses of low-molecular-weight or unfractionated heparin or fondaparinux is mandatory for all COVID-19-positive inpatients throughout the entire period of hospitalization. If there are the absolute contraindications to anticoagulation, it is recommended to use compression therapy or to perform vena cava filter implantation. Most patients with the confirmed COVID-19-associated venous thromboembolism (VTE) or those with its reasonable suspicion should be prescribed a full treatment dose of anticoagulant. In ambulatory conditions for secondary long-term thromboprophylaxis the preference should be given to direct oral anticoagulants. Patients who had a ≥3-fold elevation of D-dimer level upon admission should continue the therapeutic anticoagulation after discharge. This literature review summarizes the latest recommendations on prevention, diagnosis, and treatment of COVID-19-associated VTE. Further research should focus on developing optimal management strategies for both inpatients and outpatients with COVID-19-associated venous thromboembolism (VTE).