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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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. |
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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. 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.</description><identifier>ISSN: 0277-0008</identifier><identifier>EISSN: 1875-9114</identifier><identifier>DOI: 10.1002/phar.2465</identifier><identifier>PMID: 33006163</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>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</subject><ispartof>Pharmacotherapy, 2020-11, Vol.40 (11), p.1130-1151</ispartof><rights>2020 Pharmacotherapy Publications, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4435-b1e614a7b5fa0c74dc81eac2c36de6ebfa120dc430f029407450593bf592d75f3</citedby><cites>FETCH-LOGICAL-c4435-b1e614a7b5fa0c74dc81eac2c36de6ebfa120dc430f029407450593bf592d75f3</cites><orcidid>0000-0002-2668-7168</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fphar.2465$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fphar.2465$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33006163$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dobesh, Paul P.</creatorcontrib><creatorcontrib>Trujillo, Toby C.</creatorcontrib><title>Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID‐19</title><title>Pharmacotherapy</title><addtitle>Pharmacotherapy</addtitle><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.</description><subject>Anticoagulants</subject><subject>Anticoagulants - administration & dosage</subject><subject>Anticoagulants - adverse effects</subject><subject>Anticoagulants - therapeutic use</subject><subject>anticoagulation</subject><subject>Blood Coagulation - drug effects</subject><subject>Blood Coagulation Disorders - blood</subject><subject>Blood Coagulation Disorders - drug therapy</subject><subject>Blood Coagulation Disorders - etiology</subject><subject>Clinical trials</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>COVID-19 - blood</subject><subject>COVID-19 - complications</subject><subject>COVID-19 - drug therapy</subject><subject>Fibrin</subject><subject>Humans</subject><subject>Inflammation</subject><subject>International organizations</subject><subject>Pandemics</subject><subject>Pathophysiology</subject><subject>Patients</subject><subject>Practice Guidelines as Topic</subject><subject>Prophylaxis</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Respiratory diseases</subject><subject>Respiratory distress syndrome</subject><subject>Review of Therapeutics</subject><subject>Reviews of Therapeutics</subject><subject>SARS-CoV-2</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Thromboembolism</subject><subject>thrombosis</subject><subject>venous thromboembolism</subject><subject>Venous Thromboembolism - blood</subject><subject>Venous Thromboembolism - drug therapy</subject><subject>Venous Thromboembolism - etiology</subject><issn>0277-0008</issn><issn>1875-9114</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kd1KHDEUx4NUdLt60RcoA70SHD353rkpLNtWBUEp6m3IZDJOZHayTWYqe9dH6DP2Scx-uOhFL0IC55ff-XMOQp8wnGEAcr5odDgjTPA9NMITyfMCY_YBjYBImQPA5BB9jPEpoVgwcoAOKQUQWNARup95_Ti0fqH7ZnmaPdjODzG7a4Kfl96m07o4P810V2XTrndmTeve-S5zXXabXrbrY_bs-iab3Txcffv35y8ujtB-rdtoj7f3GN3_-H43u8yvby6uZtPr3DBGeV5iKzDTsuS1BiNZZSbYakMMFZUVtqw1JlAZRqEGUjCQjAMvaFnzglSS13SMvm68i6Gc28qkLEG3ahHcXIel8tqp95XONerR_1aSUwlCJMGXrSD4X4ONvXryQ-hSZpXmSRifUAyJOtlQJvgYg613HTCo1QbUagOrHzyxn99G2pGvI0_A-QZ4dq1d_t-kbi-nP9fKF8Vmkhc</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Dobesh, Paul P.</creator><creator>Trujillo, Toby C.</creator><general>Wiley Subscription Services, Inc</general><general>John Wiley and Sons Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2668-7168</orcidid></search><sort><creationdate>202011</creationdate><title>Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID‐19</title><author>Dobesh, Paul P. ; Trujillo, Toby C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4435-b1e614a7b5fa0c74dc81eac2c36de6ebfa120dc430f029407450593bf592d75f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anticoagulants</topic><topic>Anticoagulants - administration & dosage</topic><topic>Anticoagulants - adverse effects</topic><topic>Anticoagulants - therapeutic use</topic><topic>anticoagulation</topic><topic>Blood Coagulation - drug effects</topic><topic>Blood Coagulation Disorders - blood</topic><topic>Blood Coagulation Disorders - drug therapy</topic><topic>Blood Coagulation Disorders - etiology</topic><topic>Clinical trials</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>COVID-19 - blood</topic><topic>COVID-19 - complications</topic><topic>COVID-19 - drug therapy</topic><topic>Fibrin</topic><topic>Humans</topic><topic>Inflammation</topic><topic>International organizations</topic><topic>Pandemics</topic><topic>Pathophysiology</topic><topic>Patients</topic><topic>Practice Guidelines as Topic</topic><topic>Prophylaxis</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Respiratory diseases</topic><topic>Respiratory distress syndrome</topic><topic>Review of Therapeutics</topic><topic>Reviews of Therapeutics</topic><topic>SARS-CoV-2</topic><topic>Severe acute respiratory syndrome coronavirus 2</topic><topic>Thromboembolism</topic><topic>thrombosis</topic><topic>venous thromboembolism</topic><topic>Venous Thromboembolism - blood</topic><topic>Venous Thromboembolism - drug therapy</topic><topic>Venous Thromboembolism - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dobesh, Paul P.</creatorcontrib><creatorcontrib>Trujillo, Toby C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pharmacotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dobesh, Paul P.</au><au>Trujillo, Toby C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID‐19</atitle><jtitle>Pharmacotherapy</jtitle><addtitle>Pharmacotherapy</addtitle><date>2020-11</date><risdate>2020</risdate><volume>40</volume><issue>11</issue><spage>1130</spage><epage>1151</epage><pages>1130-1151</pages><issn>0277-0008</issn><eissn>1875-9114</eissn><abstract>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.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33006163</pmid><doi>10.1002/phar.2465</doi><tpages>23</tpages><orcidid>https://orcid.org/0000-0002-2668-7168</orcidid><oa>free_for_read</oa></addata></record> |
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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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