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Practical Recommendations for Optimal Thromboprophylaxis in Patients with COVID-19: A Consensus Statement Based on Available Clinical Trials
Coronavirus disease 2019 (COVID-19) has been shown to be strongly associated with increased risk for venous thromboembolism events (VTE) mainly in the inpatient but also in the outpatient setting. Pharmacologic thromboprophylaxis has been shown to offer significant benefits in terms of reducing not...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9604499/ https://www.ncbi.nlm.nih.gov/pubmed/36294316 http://dx.doi.org/10.3390/jcm11205997 |
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author | Kyriakoulis, Konstantinos G. Dimakakos, Evangelos Kyriakoulis, Ioannis G. Catalano, Mariella Spyropoulos, Alex C. Schulman, Sam Douketis, James Falanga, Anna Maraveyas, Anthony Olinic, Dan-Mircea Belch, Jill Gerotziafas, Grigorios Syrigos, Konstantinos Kollias, Anastasios |
author_facet | Kyriakoulis, Konstantinos G. Dimakakos, Evangelos Kyriakoulis, Ioannis G. Catalano, Mariella Spyropoulos, Alex C. Schulman, Sam Douketis, James Falanga, Anna Maraveyas, Anthony Olinic, Dan-Mircea Belch, Jill Gerotziafas, Grigorios Syrigos, Konstantinos Kollias, Anastasios |
author_sort | Kyriakoulis, Konstantinos G. |
collection | PubMed |
description | Coronavirus disease 2019 (COVID-19) has been shown to be strongly associated with increased risk for venous thromboembolism events (VTE) mainly in the inpatient but also in the outpatient setting. Pharmacologic thromboprophylaxis has been shown to offer significant benefits in terms of reducing not only VTE events but also mortality, especially in acutely ill patients with COVID-19. Although the main source of evidence is derived from observational studies with several limitations, thromboprophylaxis is currently recommended for all hospitalized patients with acceptable bleeding risk by all national and international guidelines. Recently, high quality data from randomized controlled trials (RCTs) further support the role of thromboprophylaxis and provide insights into the optimal thromboprophylaxis strategy. The aim of this statement is to systematically review all the available evidence derived from RCTs regarding thromboprophylaxis strategies in patients with COVID-19 in different settings (either inpatient or outpatient) and provide evidence-based guidance to practical questions in everyday clinical practice. Clinical questions accompanied by practical recommendations are provided based on data derived from 20 RCTs that were identified and included in the present study. Overall, the main conclusions are: (i) thromboprophylaxis should be administered in all hospitalized patients with COVID-19, (ii) an optimal dose of inpatient thromboprophylaxis is dependent upon the severity of COVID-19, (iii) thromboprophylaxis should be administered on an individualized basis in post-discharge patients with COVID-19 with high thrombotic risk, and (iv) thromboprophylaxis should not be routinely administered in outpatients. Changes regarding the dominant SARS-CoV-2 variants, the wide immunization status (increasing rates of vaccination and reinfections), and the availability of antiviral therapies and monoclonal antibodies might affect the characteristics of patients with COVID-19; thus, future studies will inform us about the thrombotic risk and the optimal therapeutic strategies for these patients. |
format | Online Article Text |
id | pubmed-9604499 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-96044992022-10-27 Practical Recommendations for Optimal Thromboprophylaxis in Patients with COVID-19: A Consensus Statement Based on Available Clinical Trials Kyriakoulis, Konstantinos G. Dimakakos, Evangelos Kyriakoulis, Ioannis G. Catalano, Mariella Spyropoulos, Alex C. Schulman, Sam Douketis, James Falanga, Anna Maraveyas, Anthony Olinic, Dan-Mircea Belch, Jill Gerotziafas, Grigorios Syrigos, Konstantinos Kollias, Anastasios J Clin Med Review Coronavirus disease 2019 (COVID-19) has been shown to be strongly associated with increased risk for venous thromboembolism events (VTE) mainly in the inpatient but also in the outpatient setting. Pharmacologic thromboprophylaxis has been shown to offer significant benefits in terms of reducing not only VTE events but also mortality, especially in acutely ill patients with COVID-19. Although the main source of evidence is derived from observational studies with several limitations, thromboprophylaxis is currently recommended for all hospitalized patients with acceptable bleeding risk by all national and international guidelines. Recently, high quality data from randomized controlled trials (RCTs) further support the role of thromboprophylaxis and provide insights into the optimal thromboprophylaxis strategy. The aim of this statement is to systematically review all the available evidence derived from RCTs regarding thromboprophylaxis strategies in patients with COVID-19 in different settings (either inpatient or outpatient) and provide evidence-based guidance to practical questions in everyday clinical practice. Clinical questions accompanied by practical recommendations are provided based on data derived from 20 RCTs that were identified and included in the present study. Overall, the main conclusions are: (i) thromboprophylaxis should be administered in all hospitalized patients with COVID-19, (ii) an optimal dose of inpatient thromboprophylaxis is dependent upon the severity of COVID-19, (iii) thromboprophylaxis should be administered on an individualized basis in post-discharge patients with COVID-19 with high thrombotic risk, and (iv) thromboprophylaxis should not be routinely administered in outpatients. Changes regarding the dominant SARS-CoV-2 variants, the wide immunization status (increasing rates of vaccination and reinfections), and the availability of antiviral therapies and monoclonal antibodies might affect the characteristics of patients with COVID-19; thus, future studies will inform us about the thrombotic risk and the optimal therapeutic strategies for these patients. MDPI 2022-10-11 /pmc/articles/PMC9604499/ /pubmed/36294316 http://dx.doi.org/10.3390/jcm11205997 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Kyriakoulis, Konstantinos G. Dimakakos, Evangelos Kyriakoulis, Ioannis G. Catalano, Mariella Spyropoulos, Alex C. Schulman, Sam Douketis, James Falanga, Anna Maraveyas, Anthony Olinic, Dan-Mircea Belch, Jill Gerotziafas, Grigorios Syrigos, Konstantinos Kollias, Anastasios Practical Recommendations for Optimal Thromboprophylaxis in Patients with COVID-19: A Consensus Statement Based on Available Clinical Trials |
title | Practical Recommendations for Optimal Thromboprophylaxis in Patients with COVID-19: A Consensus Statement Based on Available Clinical Trials |
title_full | Practical Recommendations for Optimal Thromboprophylaxis in Patients with COVID-19: A Consensus Statement Based on Available Clinical Trials |
title_fullStr | Practical Recommendations for Optimal Thromboprophylaxis in Patients with COVID-19: A Consensus Statement Based on Available Clinical Trials |
title_full_unstemmed | Practical Recommendations for Optimal Thromboprophylaxis in Patients with COVID-19: A Consensus Statement Based on Available Clinical Trials |
title_short | Practical Recommendations for Optimal Thromboprophylaxis in Patients with COVID-19: A Consensus Statement Based on Available Clinical Trials |
title_sort | practical recommendations for optimal thromboprophylaxis in patients with covid-19: a consensus statement based on available clinical trials |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9604499/ https://www.ncbi.nlm.nih.gov/pubmed/36294316 http://dx.doi.org/10.3390/jcm11205997 |
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