Subject(s)
COVID-19 , Hemophilia A , Adult , Humans , Hemophilia A/complications , Hemophilia A/epidemiology , Prevalence , COVID-19/epidemiology , Europe/epidemiology , HospitalizationABSTRACT
The COVID-19 pandemic is an ongoing global healthcare crisis. Based on reports of atypically located thromboses following vaccination with the AstraZeneca COVID-19 vaccine, the Society of Thrombosis and Haemostasis Research (GTH) has issued guidance statements on the recognition, diagnosis, and treatment of this rare complication. It shares pathophysiological features with heparin-induced thrombocytopenia (HIT) and is referred to as vaccine-induced prothrombotic immune thrombocytopenia (VIPIT).
Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Thrombosis/diagnosis , COVID-19/pathology , COVID-19/virology , COVID-19 Vaccines/administration & dosage , Guidelines as Topic , Heparin/adverse effects , Humans , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/etiology , Risk Factors , SARS-CoV-2/isolation & purification , Thrombosis/etiologyABSTRACT
The novel coronavirus, SARS-CoV-2, is causing a global pandemic of life-threatening multiorgan disease, called COVID-19. Accumulating evidence indicates that patients with COVID-19 are at significant risk of thromboembolic complications, mainly affecting the venous, but also the arterial vascular system. While the risk of venous thromboembolism (VTE) appears to be higher in patients requiring intensive care unit support compared to those admitted to general wards, recent autopsy findings and data on the timing of VTE diagnosis relative to hospitalization clearly suggest that thromboembolic events also contribute to morbidity and mortality in the ambulatory setting. In addition to a severe hypercoagulable state caused by systemic inflammation and viral endotheliitis, some patients with advanced COVID-19 may develop a coagulopathy, which meets established laboratory criteria for disseminated intravascular coagulation, but is not typically associated with relevant bleeding. Similar to other medical societies, the Society of Thrombosis and Haemostasis Research has issued empirical recommendations on initiation, dosing, and duration of pharmacological VTE prophylaxis in COVID-19 patients.
Subject(s)
Blood Coagulation Disorders/etiology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Venous Thromboembolism/prevention & control , Anticoagulants/therapeutic use , Autopsy/statistics & numerical data , Betacoronavirus/isolation & purification , Blood Coagulation Disorders/epidemiology , COVID-19 , Case-Control Studies , China/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/pathology , Coronavirus Infections/virology , Disseminated Intravascular Coagulation/blood , Disseminated Intravascular Coagulation/diagnosis , Disseminated Intravascular Coagulation/physiopathology , Heparin, Low-Molecular-Weight/therapeutic use , Hospitalization , Humans , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , SARS-CoV-2 , Survivors/statistics & numerical data , Systemic Inflammatory Response Syndrome/physiopathology , Systemic Inflammatory Response Syndrome/virology , Thrombophilia/etiology , Venous Thromboembolism/drug therapy , Venous Thromboembolism/mortalityABSTRACT
As observed in other infections with a systemic inflammatory response, severe COVID-19 is associated with hypercoagulability and a prothrombotic state. Currently, there is growing evidence that pulmonary embolism and thrombosis contribute to adverse outcomes and increased mortality in critically ill patients with COVID-19. The optimal thromboprophylactic regimen for patients with COVID-19 is not known. Whereas pharmacologic thromboprophylaxis is generally recommended for all hospitalized COVID-19 patients, adequate dosing of anticoagulants remains a controversial issue. Therefore, we summarize current evidence from the available literature and, on behalf of the German Society of Angiology (DGA), we aim to provide advice to establish an improved and more uniform strategy for thromboprophylaxis in patients with COVID-19.