Management of Thrombotic Complications in COVID-19: An Update

Drugs. 2020 Oct;80(15):1553-1562. doi: 10.1007/s40265-020-01377-x.

Abstract

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2), is now a global pandemic. This virus primarily affects the respiratory tract and causes lung injury characterized by acute respiratory distress syndrome. Although the pathophysiology of COVID-19 is not yet clear, the most widely accepted mechanism is systemic inflammation. A clinically significant effect of the inflammation is coagulopathy. As a result of this effect, patients are found to have a high risk of venous thromboembolism. Studies have reported a high incidence of thrombotic complications in critically ill patients with COVID-19. In this review, we discuss the most updated evidence on the pathophysiology, diagnosis, and treatment of the coagulopathy of COVID-19. Prophylactic anticoagulation is recommended for all in-patients with COVID-19. Those with a higher risk of developing thromboembolic events or who have already developed venous thromboembolism should be treated with therapeutic anticoagulation. We also discuss post-discharge prophylaxis for high-risk patients and some newly proposed treatments for the hypercoagulability that could improve the outcomes of the affected patients.

Publication types

  • Review

MeSH terms

  • Anticoagulants / administration & dosage
  • Betacoronavirus / isolation & purification
  • COVID-19
  • Coronavirus Infections / complications*
  • Critical Illness
  • Humans
  • Pandemics
  • Pneumonia, Viral / complications*
  • SARS-CoV-2
  • Thrombosis / prevention & control*
  • Thrombosis / virology
  • Venous Thromboembolism / prevention & control*
  • Venous Thromboembolism / virology

Substances

  • Anticoagulants