The medical world's understanding of COVID-19 is constantly evolving. This poll was initiated amid the realization that the frequently reported abnormal coagulation profiles of patients with COVID-19 clearly translate into a significant risk for clinical thrombotic events manifested as strokes (often in young persons), peripheral vascular occlusions, deep vein thrombosis, and pulmonary embolus (traditional embolic as well as frequent in situ micro emboli).^1,2 The consequence has been a growing belief that patients with COVID-19 without specific risk of bleeding complications should receive guideline-recommended intravenous, oral, or subcutaneous antithrombotic prophylaxis.

The poll respondents appear to have gotten it right regarding recognizing the reported frequency of thrombotic events and the need for prophylaxis. Only 6% of respondents did not use prophylaxis at all. The remainder did use in 25% or more of patients with COVID-19, with 70% treating 50% or more of their patients. In a recent publication, Paranjpe et al.³ reported significantly reduced mortality for ventilated patients with COVID-19 on anticoagulants (29.1%) versus 62.7% for those not receiving anticoagulation. Bleeding events were not significantly higher for the anticoagulated patients. The authors note more data, ideally randomized, are needed to affirm these findings.

In summary, baseline coagulation profiles are often abnormal, likely contributing to the frequency of thrombotic events in patients with COVID-19. Prophylactic anticoagulants may reduce the risk of thrombotic events, but decisions should be individualized to minimize bleeding complications.

References

1. Oxley TJ, Mocco J, Majidi S, et al. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. N Engl J Med 2020;382:e60.
2. Lax SF, Skok K, Zechner P, et al. Pulmonary Arterial Thrombosis in COVID-19 With Fatal Outcome: Results From a Prospective, Single-Center, Clinicopathologic Case Series. Ann Intern Med 2020;May 14:[Epub ahead of print].
3. Paranjpe I, Fuster V, Lala A, et al. Association of Treatment Dose Anticoagulation With In-Hospital Survival Among Hospitalized Patients With COVID-19. J Am Coll Cardiol 2020;May 5:[Epub ahead of print].

Clinical Topics: Anticoagulation Management, COVID-19 Hub, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Vascular Medicine, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Nuclear Imaging

Keywords: Coronary Angiography, COVID-19, Coronavirus, Coronavirus Infections, severe acute respiratory syndrome coronavirus 2, Anticoagulants, Fibrinolytic Agents, Respiration, Artificial, Venous Thrombosis, Pulmonary Embolism, Thrombosis, Hemorrhage, Stroke

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