Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID‐19

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has led to a worldwide pandemic, and patients with the infection are referred to as having COVID‐19. Although COVID‐19 is commonly considered a respiratory disease, there is clearly a thrombotic potential that was not expected. The pathoph...

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Veröffentlicht in:Pharmacotherapy 2020-11, Vol.40 (11), p.1130-1151
Hauptverfasser: Dobesh, Paul P., Trujillo, Toby C.
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description Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has led to a worldwide pandemic, and patients with the infection are referred to as having COVID‐19. Although COVID‐19 is commonly considered a respiratory disease, there is clearly a thrombotic potential that was not expected. The pathophysiology of the disease and subsequent coagulopathy produce an inflammatory, hypercoagulable, and hypofibrinolytic state. Several observational studies have demonstrated surprisingly high rates of venous thromboembolism (VTE) in both general ward and intensive care patients with COVID‐19. Many of these observational studies demonstrate high rates of VTE despite patients being on standard, or even higher intensity, pharmacologic VTE prophylaxis. Fibrinolytic therapy has also been used in patients with acute respiratory distress syndrome. Unfortunately, high quality randomized controlled trials are lacking. A literature search was performed to provide the most up‐to‐date information on the pathophysiology, coagulopathy, risk of VTE, and prevention and treatment of VTE in patients with COVID‐19. These topics are reviewed in detail, along with practical issues of anticoagulant selection and duration. Although many international organizations have produced guidelines or consensus statements, they do not all cover the same issues regarding anticoagulant therapy for patients with COVID‐19, and they do not all agree. These statements and the most recent literature are combined into a list of clinical considerations that clinicians can use for the prevention and treatment of VTE in patients with COVID‐19.
doi_str_mv 10.1002/phar.2465
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Although COVID‐19 is commonly considered a respiratory disease, there is clearly a thrombotic potential that was not expected. The pathophysiology of the disease and subsequent coagulopathy produce an inflammatory, hypercoagulable, and hypofibrinolytic state. Several observational studies have demonstrated surprisingly high rates of venous thromboembolism (VTE) in both general ward and intensive care patients with COVID‐19. Many of these observational studies demonstrate high rates of VTE despite patients being on standard, or even higher intensity, pharmacologic VTE prophylaxis. Fibrinolytic therapy has also been used in patients with acute respiratory distress syndrome. Unfortunately, high quality randomized controlled trials are lacking. A literature search was performed to provide the most up‐to‐date information on the pathophysiology, coagulopathy, risk of VTE, and prevention and treatment of VTE in patients with COVID‐19. 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subjects Anticoagulants
Anticoagulants - administration & dosage
Anticoagulants - adverse effects
Anticoagulants - therapeutic use
anticoagulation
Blood Coagulation - drug effects
Blood Coagulation Disorders - blood
Blood Coagulation Disorders - drug therapy
Blood Coagulation Disorders - etiology
Clinical trials
Coronaviruses
COVID-19
COVID-19 - blood
COVID-19 - complications
COVID-19 - drug therapy
Fibrin
Humans
Inflammation
International organizations
Pandemics
Pathophysiology
Patients
Practice Guidelines as Topic
Prophylaxis
Randomized Controlled Trials as Topic
Respiratory diseases
Respiratory distress syndrome
Review of Therapeutics
Reviews of Therapeutics
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Thromboembolism
thrombosis
venous thromboembolism
Venous Thromboembolism - blood
Venous Thromboembolism - drug therapy
Venous Thromboembolism - etiology
title Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID‐19
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