The COVID-19 pandemic has implications in the prevention and management of patients with thrombotic and thromboembolic disease, according to a state-of-the-art review published April 17 in the Journal of the American College of Cardiology.

Behnood Bikdeli, MD, MS, et al., summarize the pathogenesis, epidemiology, treatment and available outcomes data related to thrombotic disease in COVID-19 patients, as well as management of thrombotic events in patients without COVID-19, providing clinical guidance when possible.

The authors outline investigational therapies for COVID-19 and their interactions, as well as other considerations, when used in patients taking antiplatelet agents or anticoagulants.

Strategies to prevent venous thromboembolism (VTE) are needed in patients with COVID-19, the authors note, adding that COVID-19 patients with respiratory failure or comorbidities, such as cancer or heart failure, should receive pharmacological prophylaxis.

The paper outlines considerations for medical and interventional therapy for VTE for patients with and without COVID-19 during the pandemic. In addition, the authors summarize considerations for patients with COVID-19 and acute coronary syndromes treated with both antithrombotic therapy and interventional therapies.

According to the authors, additional data are needed to understand how COVID-19 interacts with thrombotic diseases and help clinicians optimize outcomes in COVID-19 patients with pre-existing and incident thromboembolic disease.

The authors note that their guidance "should supplement, rather than supplant, clinical decision-making."

"Important considerations for the preventive and therapeutic use of antithrombotic agents should be kept in mind to mitigate the thrombotic and hemorrhagic events" in high-risk COVID-19 patients who also have pre-existing or incident thrombotic disease.

The review, authored by an international, collaborative of clinicians and investigators, is endorsed by the International Society on Thrombosis and Haemostasis, North American Thrombosis Forum, European Society of Vascular Medicine, and the International Union of Angiology, and supported by the ESC Working Group on the Pulmonary Circulation and Right Ventricular Function.

Clinical Topics: Acute Coronary Syndromes, Anticoagulation Management, COVID-19 Hub, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Anticoagulation Management and ACS, Anticoagulation Management and Venothromboembolism

Keywords: Fibrinolytic Agents, Platelet Aggregation Inhibitors, Anticoagulants, Venous Thromboembolism, Acute Coronary Syndrome, Ventricular Function, Right, Pulmonary Circulation, Pandemics, COVID-19, Coronavirus, Coronavirus Infections, severe acute respiratory syndrome coronavirus 2, Thrombosis, Hemorrhage, Hemostasis

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