ABSTRACT
In patients with coronavirus disease 2019 (COVID-19), the prevalence of pre-existing cardiovascular diseases is elevated. Moreover, various features, also including pro-thrombotic status, further predispose these patients to increased risk of ischemic cardiovascular events. Thus, the identification of optimal antithrombotic strategies in terms of the risk-benefit ratio and outcome improvement in this setting is crucial. However, debated issues on antithrombotic therapies in patients with COVID-19 are multiple and relevant. In this article, we provide ten questions and answers on risk stratification and antiplatelet/anticoagulant treatments in patients at risk of/with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on the scientific evidence gathered during the pandemic.
Subject(s)
Anticoagulants/pharmacology , Anticoagulants/therapeutic use , COVID-19/complications , Thrombosis/etiology , Thrombosis/prevention & control , Age Factors , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Anticoagulants/administration & dosage , Anticoagulants/classification , Antiviral Agents/pharmacology , Atrial Fibrillation/drug therapy , Chemoprevention/adverse effects , Chemoprevention/methods , Disseminated Intravascular Coagulation/drug therapy , Drug Interactions , Humans , Italy , Pandemics , Risk Factors , Risk Management , SARS-CoV-2 , Severity of Illness Index , Sex Factors , Thrombosis/drug therapy , Thrombosis/physiopathologyABSTRACT
Given the high prevalence of preexisting cardiovascular diseases and the increased incidence of adverse cardiovascular events in patients hospitalized for SARS-CoV-2 infection, the identification of optimal antithrombotic approaches in terms of risk/benefit ratio and outcome improvement appears crucial in this setting. In the present position paper we collected current evidence from the literature to provide practical recommendations on the management of antithrombotic therapies (antiplatelet and anticoagulant) in various clinical contexts prevalent during the SARS-CoV-2 outbreak: in-home management of oral anticoagulant therapy; interactions between drugs used in the SARS-CoV-2 infection and antithrombotic agents; in-hospital management of antithrombotic therapies; diagnosis, risk stratification and treatment of in-hospital thrombotic complications.