Thromboprophylaxis in Patients With COVID-19

BACKGROUND

Hospitalized patients of COVID-19 are often observed to have biomarkers of hypercoagulable state with an increased chance of incidence of VTE. In response to this, CHEST issued a rapid clinical guidance for  prevention of VTE by incorporating the improved evidence updated in the past 18 months.  

STUDY DESIGN AND METHODS

The research focused on the question of finding the optimal approach to thromboprophylaxis in hospitalized patients. To obtain the answers MEDLINE is searched and eight randomized controlled trials and one observational study were included in the study and a meta-analysis was performed. The panel created summaries using the GRADE Evidence-to-Decision framework. Updated guidance statements were drafted, and a modified Delphi approach was used for obtaining consensus.

RESULTS

Separate guidance statements are provided for VTE prevention in hospitalized patients with acute (moderate) illness and critically ill patients in the ICU. Each of the original questions and recommendations are divided into two questions: standard prophylaxis vs therapeutic (or escalated dose) prophylaxis and standard prophylaxis vs intermediate dose prophylaxis. As a result three additional recommendations are obtained based upon higher quality evidence.

CONCLUSION

Advances in care for patients with COVID-19 have improved overall outcomes. However, incidence of VTE in those patients remains elevated. It has been recommended to provide standard thromboprophylaxis for VTE in critically ill patients, and moderately ill patients with a low bleeding risk might benefit from therapeutic heparin. 

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