Authors: Brosnahan SB, Bhatt A, Berger JS, Yuriditsky E, Iturrate E
PMID: 32589950 PMCID: PMC7309731 DOI: 10.1016/j.chest.2020.06.023
Abstract
VTE is an important, dangerous, and sometimes fatal complication of coronavirus disease 2019 (COVID-19). Thrombosis, including ischemic heart disease and stroke, contributes to the overall disease burden in all non-COVID patient populations worldwide, accounting for approximately one in four deaths.
Current guidelines recommend chemical prophylaxis in all patients with COVID-19 who are admitted to the hospital; however, after discharge, recommendations are not addressed. The benefit of extending VTE prophylaxis after discharge has been observed to be safe and effective in some high-risk populations. Simple laboratory makers, which include D-dimer and C-reactive protein (CRP), can be especially important in choosing who may benefit from extended VTE prophylaxis. To date, there have been no randomized studies to study extending VTE prophylaxis in the COVID-19 patient population.
This series describes clinical observations at a large academic hospital center in New York City that are related to increased rates of thrombotic events in patients re-presenting to health care within a short timeframe after an index COVID-19 admission. These patients re-presented with presumed thromboembolic complications, both arterial and venous. Most of these cases resulted in acute and rapid decline at re-presentation that led to death. These observations have raised our concern regarding a continued hypercoagulable state in patients with COVID-19, despite clinical stability that exists after hospitalization; patients with certain risk factors may benefit from extended VTE prophylaxis.
Keywords: COVID-19, COVID-19 pneumonia, thrombosis
