CHEST expert panel issues guidelines for the prevention, diagnosis and treatment of venous thromboembolism in patients with COVID-19
June 2, 2020
Glenview, Illinois – With the novel coronavirus (COVID-19) sweeping the globe and causing significant morbidity and mortality, urgent clinical questions regarding the prevention, diagnosis and treatment of venous thromboembolism (VTE) in patients have emerged. A set of guidelines prepared by an American College of Chest Physicians® (CHEST) panel of experts provides 21 optimal strategies when treating patients with VTE and COVID-19.
Like more general data on COVID-19, evidence for the management of venous thromboembolism in patients with COVID-19 is sparse, but rapidly evolving. Emerging reports show that severe COVID-19 can be complicated by coagulopathy. In the most severe cases, this manifests as disseminated intravascular coagulation (DIC), which is a prothrombotic condition with a high risk of VTE. The presence of DIC has been found to be a strong predictor of mortality.
The panel leveraged evidence-based methods in assessing the literature and drew on CHEST’s flagship guidelines in antithrombotic therapy and prevention to offer guidance from established management strategies where COVID-specific suggestions could not be provided.
“These guidance statements were specifically created to address common, urgent clinical questions that frontline providers are likely to face regarding venous thromboembolism and hypercoagulability in patients with COVID-19,” stated lead author Lisa K. Moores, MD, FCCP, of F. Edward Hebert School of Medicine, Bethesda, MD. “It is important to note the lack of direct evidence available at this time. More is being shared daily, but this emphasizes the importance of enrolling patients in clinical trials whenever possible and the need for international collaboration in collecting and rapidly disseminating relevant clinical experience.”
The goal of the panel with this guidance statement is to translate available evidence into a list of practical recommendations. The guidelines presented in the report include the following recommendations:
- In the absence of contraindication, coagulant thromboprophylaxis is recommended in critically ill patients with COVID-19 and suggested for use in acutely ill hospitalized patients with COVID-19.
- In critically ill or acutely ill hospitalized patients with COVID-19, the panel recommends against the use of antiplatelet agents for VTE prevention.
- In acutely ill hospitalized patients with COVID-19, anticoagulant thromboprophylaxis with low-molecular-weight heparin (LMWH) or fondaparinux over anticoagulant thromboprophylaxis with unfractionated heparin (UFH) is suggested, and anticoagulant thromboprophylaxis with LMWH, fondaparinux or UFH over anticoagulant thromboprophylaxis with a direct oral anticoagulant is recommended.
- In critically ill patients with COVID-19, the panel suggests against routine ultrasound screening for the detection of asymptomatic deep vein thrombosis (DVT).
In noting the limitations of the report, the panel states that the current body of evidence does not allow for delineation between macro (DVT/PE) and microthrombosis, and the approach to these may differ, which could drive at least a portion of mortality in these patients.
“We believe this document, given the current coagulopathy concerns around COVID-19, provides additional guidance for physicians and other health care providers and encourages them to participate in clinical trials supporting evidence-based treatment decisions for all patients,” said Steven Q. Simpson, MD, FCCP, President-Elect of CHEST.
The full list of recommendations and an explanation of the methodology applied is available on the journal CHEST® website. CHEST will continue to release additional resources in response to the COVID-19 pandemic to support physicians and patients. For additional resources, go to chestnet.org
Read more: https://journal.chestnet.org/article/S0012-3692(20)31625-1/fulltext
About the journal CHEST
The journal
CHEST®, the official publication of the American College of Chest Physicians, features the best in peer-reviewed, cutting-edge original research in the multidisciplinary specialties of chest medicine: pulmonary, critical care and sleep medicine; thoracic surgery; cardiorespiratory interactions; and related disciplines. Published since 1935, it is home to the highly regarded clinical practice guidelines and consensus statements. Readers find the latest research posted in the Online First section each week and access series that provide insight into relevant clinical areas, such as Recent Advances in Chest Medicine; Topics in Practice Management; Pulmonary, Critical Care and Sleep Pearls; Ultrasound Corner; Chest Imaging and Pathology for Clinicians; and Contemporary Reviews. Point/Counterpoint Editorials and the journal
CHEST Podcasts address controversial issues, fostering discussion among physicians.
www.chestjournal.org
About the American College of Chest Physicians
The American College of Chest Physicians® (CHEST) is the global leader in the prevention, diagnosis and treatment of chest diseases. Its mission is to champion advanced clinical practice, education communication and research in chest medicine. It serves as an essential connection to clinical knowledge and resources for its 19,000+ members from around the world who provide patient care in pulmonary, critical care and sleep medicine. For information about the American College of Chest Physicians, and its flagship journal CHEST®, visit chestnet.org.
About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support and professional education, including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray’s Anatomy. Elsevier is part of RELX Group, a global provider of information and analytics for professionals and business customers across industries. www.elsevier.com
Full text of this article and interviews are available to credentialed journalists upon request; contact American College of Chest Physicians, at media@chestnet.org.