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Physician experiences in management of COVID-19-associated coagulopathy in pregnancy: Communication from the ISTH SSC Subcommittee on Women's Health Issues in Thrombosis and Haemostasis.
Jevtic, Stefan D; Malinowski, Ann Kinga; Othman, Maha; Abdul Kadir, Rezan A.
  • Jevtic SD; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Malinowski AK; Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.
  • Othman M; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada.
  • Abdul Kadir RA; Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, ON, Canada.
J Thromb Haemost ; 19(10): 2539-2545, 2021 10.
Article in English | MEDLINE | ID: covidwho-1309787
ABSTRACT

BACKGROUND:

Coronavirus disease 2019 (COVID-19) occurs following infection with the potentially fatal, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. Infection can be complicated by coagulopathy, at times featuring thrombocytopenia and thrombosis alongside other coagulation abnormalities, also termed COVID-19-associated coagulopathy (CAC). Data concerning CAC in pregnancy are limited. Better understanding of physician experiences is essential to identify current practice patterns and knowledge gaps.

OBJECTIVES:

To determine physician experiences and practice patterns regarding CAC in pregnancy.

METHODS:

Self-administered survey using the RedCap online platform; supported by the ISTH Subcommittee on Women's Health Issues in Thrombosis and Hemostasis.

RESULTS:

Seventy-five respondents fully or partially completed the survey. Of 1546 reported cases, disease severity was specified in 1298. Sixty-four percent of COVID-19 infections were mild, whereas 4% were severe. Of all cases, 1% developed CAC, with 65% classified as severe. The most frequent abnormalities included thrombocytopenia, elevated C-reactive protein, D-dimer, and lymphopenia. Low molecular weight heparin was the anticoagulant of choice in CAC and was provided by 77% of respondents, with 60% using standard prophylactic dosing. Thrombosis occurred in seven anticoagulated patients who were receiving standard prophylactic (four) or weight-based (three) dosing. Disease severity and additional thrombosis risk factors dictated anticoagulation duration.

CONCLUSION:

In the select population reported by our survey, CAC appears to be uncommon in pregnancy. Anticoagulation practices vary and may not reflect current guidelines. Venous thromboembolism was observed in some CAC patients despite prophylactic anticoagulation (including standard and weight-adjusted dosing). Urgent research is required to determine appropriate anticoagulant dosing and duration in pregnant women with COVID-19 infection.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Physicians / Thrombosis / COVID-19 Type of study: Observational study / Prognostic study / Qualitative research Limits: Female / Humans / Pregnancy Language: English Journal: J Thromb Haemost Journal subject: Hematology Year: 2021 Document Type: Article Affiliation country: Jth.15462

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Physicians / Thrombosis / COVID-19 Type of study: Observational study / Prognostic study / Qualitative research Limits: Female / Humans / Pregnancy Language: English Journal: J Thromb Haemost Journal subject: Hematology Year: 2021 Document Type: Article Affiliation country: Jth.15462