Abstract

Introduction: Novel coronavirus (COVID-19) infection is reportedly associated with a high risk of thromboembolic complications. This review provides an overview of the current knowledge about the management of venous thromboembolism in coronavirus disease.

Methods: An online search of literature through PubMed and google scholar was done using the term “COVID-19”, “treatment”, “thromboembolism”, “antiplatelet”, “antithrombolytics” and “anticoagulants”. Articles were chosen for inclusion based on their relevance to coagulopathy and thrombosis in coronavirus disease and anticoagulant therapy. Reference lists were also reviewed to select additional relevant articles.

Results: Average incidence of thromboembolism in hospitalized COVID-19 patients varied between 25-53%. D-dimer was the most frequent coagulopathy marker used to assess the severity of the disease. If there is any suspicion of deep vein thrombosis (DVT), diagnosis is primarily based on bedside clinical examinations and then objectively confirmed by imaging studies. Low-molecular-weight heparin (LMWH) is reported as the first line drug in the treatment of thromboembolism associated with COVID-19. There is currently no high quality evidence for administering thrombolytic for the treatment of COVID-19 pulmonary microthrombi. Prophylaxis is considered in patients at greatest risk, especially those with reduced mobility and a previous history of venous thromboembolism (VTE) or active malignancy. The selection of drugs and dosing should be considered based on recommendations of the current standards.

Conclusion: Anticoagulant therapy with low molecular weight heparin appears to be associated with better prognosis in severe COVID-19 patients meeting Sepsis-Induced Coagulopathy (SIC) criteria or with markedly elevated D-dimer. Despite the use of anticoagulant prophylaxis, the thrombotic risk is high and optimum dosage of anticoagulation is not yet established.

Keywords: Coagulopathy; Coronavirus Disease 2019; Hypercoagulability; Thromboembolism

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