Guideline in Focus
Antithrombotic Therapy in COVID-19

Increasing evidence shows that the risk of thrombotic complications in COVID-19 is associated with a hypercoagulable state. This guideline provides recommendations for managing four arterial (pro)thrombotic medical conditions in patients with COVID-19 and assessing the risks and benefits of additional medication.

PUBLISHED June 29, 2023



Key Recommendations

In hospitalized patients with COVID-19 and confirmed acute coronary syndrome (ACS), we recommend dual antiplatelet therapy to reduce the risk of recurrent ACS or death.

In outpatients with COVID-19 receiving antiplatelet therapy for a previous stroke, we suggest against the addition of or change to oral or subcutaneous anticoagulation.

In non-ICU hospitalized patients with COVID-19 on oral anticoagulation for atrial fibrillation (A-fib) who require discontinuation of oral anticoagulation, we suggest switching to therapeutic dose low molecular weight heparin or unfractionated heparin.


Estimated incidence of arterial thrombosis or thromboembolism in COVID-19
Start direct oral anticoagulant (DOAC) in male outpatients with COVID and A-fib
Start DOAC in female outpatients with COVID and A-fib

Implement this guideline into practice

Our guidelines are aimed at helping you respond to today’s clinical challenges and improve patient health outcomes. Our panel of experts has developed multimedia content to facilitate adoption of this guideline into your day-to-day practice.


CHEST releases clinical practice guideline on antithrombotic therapy in arterial thrombosis and thromboembolism in COVID-19
In a release issued to the media, lead author, Tatjana Potpara, MD, PhD, speaks to the importance of this guideline in practice. It includes recommendations for patients with COVID-19 who have a history of ACS or percutaneous coronary intervention, acute stroke or transient ischemic attack, A-fib, and peripheral artery disease or acute limb ischemia.


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