Thromboembolic prevention and anticoagulant therapy during the COVID-19 pandemic: updated clinical guidance from the anticoagulation forum

Geoffrey D Barnes; Allison Burnett; Arthur Allen; Jack Ansell; Marilyn Blumenstein; Nathan P Clark; Mark Crowther; William E Dager; Steven B Deitelzweig; Stacy Ellsworth; David Garcia; Scott Kaatz; Leslie Raffini; Anita Rajasekhar; Andrea Van Beek; Tracy Minichiello

doi:10.1007/s11239-022-02643-3

Thromboembolic prevention and anticoagulant therapy during the COVID-19 pandemic: updated clinical guidance from the anticoagulation forum

J Thromb Thrombolysis. 2022 Aug;54(2):197-210. doi: 10.1007/s11239-022-02643-3. Epub 2022 May 17.

Authors

Geoffrey D Barnes¹, Allison Burnett², Arthur Allen³, Jack Ansell⁴, Marilyn Blumenstein⁵, Nathan P Clark⁶, Mark Crowther⁷, William E Dager⁸, Steven B Deitelzweig⁹, Stacy Ellsworth¹⁰, David Garcia¹¹, Scott Kaatz¹⁰, Leslie Raffini¹², Anita Rajasekhar¹³, Andrea Van Beek¹⁴, Tracy Minichiello¹⁵

Affiliations

¹ University of Michigan, 2800 Plymouth Rd, B14 G214, 48109-2800, Ann Arbor, MI, USA. [email protected].
² University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
³ VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
⁴ Professor of Medicine, Hofstra/Northwell School of Medicine , New York, USA.
⁵ Children's Hospital of Philadelphia , Philadelphia, PA, USA.
⁶ Kaiser Permanente Colorado, Colorado University Skaggs School of Pharmacy, Aurora, CO, USA.
⁷ McMaster University, Hamilton, ON, Canada.
⁸ UC Davis Medical Center, Sacramento, CA, USA.
⁹ Ochsner Health System, New Orleans, LA, USA.
¹⁰ Henry Ford Hospital, Detroit, MI, USA.
¹¹ University of Washington, Seattle, WA, USA.
¹² University of Pennsylvania Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹³ University of Florida Health, Visalia, CA, USA.
¹⁴ Kaweah Health Medical Group/Visalia Medical Clinic, Visalia, CA, USA.
¹⁵ University of California, San Francisco San Francisco VA Medical Center, San Francisco, CA, USA.

Abstract

Thromboembolism is a common and deadly consequence of COVID-19 infection for hospitalized patients. Based on clinical evidence pre-dating the COVID-19 pandemic and early observational reports, expert consensus and guidance documents have strongly encouraged the use of prophylactic anticoagulation for patients hospitalized for COVID-19 infection. More recently, multiple clinical trials and larger observational studies have provided evidence for tailoring the approach to thromboprophylaxis for patients with COVID-19. This document provides updated guidance for the use of anticoagulant therapies in patients with COVID-19 from the Anticoagulation Forum, the leading North American organization of anticoagulation providers. We discuss ambulatory, in-hospital, and post-hospital thromboprophylaxis strategies as well as provide guidance for patients with thrombotic conditions who are considering COVID-19 vaccination.

Keywords: Anticoagulation; Aspirin; COVID-19; Direct oral anticoagulant; Direct-acting oral anticoagulant; Enoxaparin; Low-molecular-weight heparin; Pregnancy; Prophylaxis; Stewardship; Thrombophilia; Thrombosis and thrombocytopenia syndrome; Venous thromboembolism; rivaroxaban.

MeSH terms

Anticoagulants / therapeutic use
COVID-19 Vaccines
COVID-19*
Humans
Pandemics
Venous Thromboembolism* / drug therapy
Venous Thromboembolism* / etiology
Venous Thromboembolism* / prevention & control

Substances

Anticoagulants
COVID-19 Vaccines