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Anticoagulation in Patients With COVID-19 JACC Review Topic of the Week

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2022)

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Article Critical Care Medicine

Impact of High-Dose Prophylactic Anticoagulation in Critically Ill Patients With COVID-19 Pneumonia

Charles Tacquard et al.

Summary: High-dose prophylactic anticoagulation is associated with a reduced risk of thrombotic complications in critically ill patients with COVID-19 without increasing the risk of bleeding. Further randomized controlled trials comparing prophylaxis with higher doses of anticoagulants are needed to confirm these results.

CHEST (2021)

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News Item Cardiac & Cardiovascular Systems

Can ACEIs and ARBs be safely continued in COVID-19:- The Evidence is here at Last!

Uma Velupandian

HEART VIEWS (2021)

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Review Critical Care Medicine

A Review of Pathophysiology, Clinical Features, and Management Options of COVID-19 Associated Coagulopathy

Julie Goswami et al.

Summary: COVID-19 is associated with significant coagulopathy, leading to increased rates of venous and arterial thromboembolic events. Inflammatory response in COVID-19 is linked to coagulopathy, posing challenges for diagnosis, prevention, and treatment of thrombotic complications. Endothelial injury and augmented innate immune response play a role in the development of thrombosis in COVID-19.

SHOCK (2021)

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Article Medicine, General & Internal

Effect of Antithrombotic Therapy on Clinical Outcomes in Outpatients With Clinically Stable Symptomatic COVID-19 The ACTIV-4B Randomized Clinical Trial

Jean M. Connors et al.

Summary: This study aimed to assess the impact of anticoagulant or antiplatelet therapy on symptomatic clinically stable outpatients with COVID-19. The results showed that treatment with aspirin or apixaban compared with placebo did not reduce the rate of a composite clinical outcome, and the study was terminated early due to a lower than anticipated event rate.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2021)

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Review Critical Care Medicine

Incidence of VTE and Bleeding Among Hospitalized Patients With Coronavirus Disease 2019 A Systematic Review and Meta-analysis

David Jimenez et al.

Summary: The pooled incidence of VTE and bleeding among hospitalized patients with COVID-19 was 17.0% and 7.8% respectively. Factors such as routine screening, critical illness, inclusion of distal DVT and subsegmental PE, and prospective studies were associated with higher rates of VTE. The incidence of bleeding events was sensitive to escalated doses of anticoagulants and the nature of data collection.

CHEST (2021)

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Article Medicine, General & Internal

Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study

Christopher T. Rentsch et al.

Summary: The study found that early initiation of prophylactic anticoagulation was associated with decreased risk of 30 day mortality among patients hospitalized with covid-19 in the United States, without increasing the risk of serious bleeding events.

BMJ-BRITISH MEDICAL JOURNAL (2021)

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Article Hematology

American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19

Adam Cuker et al.

Summary: The American Society of Hematology provided two conditional recommendations for anticoagulation in COVID-19-related critical illness and acute illness, emphasizing the low certainty in the evidence and the importance of future high-quality randomized controlled trials for validation.

BLOOD ADVANCES (2021)

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Article Medicine, General & Internal

Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial

Michelle Sholzberg et al.

Summary: This study aimed to evaluate the effects of therapeutic heparin compared with prophylactic heparin among moderately ill patients with covid-19 admitted to hospital wards. The results of the study may help guide the treatment options for similar patients in the future.

BMJ-BRITISH MEDICAL JOURNAL (2021)

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Article Medicine, General & Internal

Efficacy and Safety of Therapeutic-Dose Heparin vs Standard Prophylactic or Intermediate-Dose Heparins for Thromboprophylaxis in High-risk Hospitalized Patients With COVID-19 The HEP-COVID Randomized Clinical Trial

Alex C. Spyropoulos et al.

Summary: Therapeutic-dose low-molecular-weight heparin reduces major thromboembolism and death in high-risk inpatients with COVID-19, with no significant effect observed in critically ill patients.

JAMA INTERNAL MEDICINE (2021)

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Article Medicine, General & Internal

Effect of Intermediate-Dose vs Standard-Dose Prophylactic Anticoagulation on Thrombotic Events, Extracorporeal Membrane Oxygenation Treatment, or Mortality Among Patients With COVID-19 Admitted to the Intensive Care Unit The INSPIRATION Randomized Clinical Trial

Parham Sadeghipour et al.

Summary: This study compared the effect of intermediate-dose and standard prophylactic anticoagulation on a composite outcome among COVID-19 patients admitted to the ICU. The results showed no significant difference between the two groups in terms of thrombotic events, ECMO therapy, or mortality within 30 days. The study does not recommend routine use of intermediate-dose prophylactic anticoagulation in unselected ICU patients with COVID-19.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2021)

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Article Cardiac & Cardiovascular Systems

Recent Randomized Trials of Antithrombotic Therapy for Patients With COVID-19

Azita H. Talasaz et al.

Summary: COVID-19 induces endothelial injury and thrombosis, but the optimal thromboprophylactic regimens are still unknown across the spectrum of illness severity. Ongoing randomized controlled trials are assessing various antithrombotic agents, doses, and durations, presenting opportunities and challenges for the clinical trial enterprise.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2021)

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Article Cardiac & Cardiovascular Systems

Medically Ill hospitalized Patients for COVID-19 THrombosis Extended ProphyLaxis with rivaroxaban ThErapy: Rationale and Design of the MICHELLE Trial

Eduardo Ramacciotti et al.

Summary: The study aims to evaluate the safety and efficacy of rivaroxaban in COVID-19 patients at increased risk for VTE who received standard prophylactic treatment, as well as the role of extended thromboprophylaxis. The results are expected to guide medical decisions in clinical practice.

AMERICAN HEART JOURNAL (2021)

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Article Hematology

Postdischarge thromboembolic outcomes and mortality of hospitalized patients with COVID-19: the CORE-19 registry

Dimitrios Giannis et al.

Summary: Thromboembolic events and mortality from subclinical thrombotic events frequently occur in COVID-19 inpatients. Postdischarge VTE, ATE, and ACM are common, with advanced age and cardiovascular risk factors increasing the risk. Postdischarge anticoagulation can significantly reduce the risk by 46%.

BLOOD (2021)

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Article Hematology

Standard prophylactic versus intermediate dose enoxaparin in adults with severe COVID-19: A multi-center, open-label, randomized controlled trial

Usha S. Perepu et al.

Summary: In hospitalized adults with severe COVID-19, standard prophylactic dose and intermediate dose enoxaparin did not significantly differ in preventing death or thrombosis at 30 days. The occurrence of arterial or venous thrombosis was slightly higher than the rate of major bleeding.

JOURNAL OF THROMBOSIS AND HAEMOSTASIS (2021)

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Article Hematology

Persistent endotheliopathy in the pathogenesis of long COVID syndrome

Helen Fogarty et al.

Summary: The study found that endothelial cell activation may persist in convalescent COVID-19 patients and may contribute to the pathogenesis of long COVID. This sustained endotheliopathy was more common in older, comorbid patients, and those requiring hospitalization, indicating a potential link between endothelial dysfunction and long-term COVID symptoms.

JOURNAL OF THROMBOSIS AND HAEMOSTASIS (2021)

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Article Medicine, General & Internal

Therapeutic versus prophylactic anticoagulation for patients admitted to hospital with COVID-19 and elevated D-dimer concentration (ACTION): an open-label, multicentre, randomised, controlled trial

Renato D. Lopes et al.

Summary: In hospitalized COVID-19 patients with elevated D-dimer concentration, in-hospital therapeutic anticoagulation with rivaroxaban or enoxaparin followed by rivaroxaban to day 30 did not improve clinical outcomes and increased bleeding compared with prophylactic anticoagulation. Therapeutic-dose rivaroxaban and other direct oral anticoagulants should be avoided in these patients without an evidence-based indication for oral anticoagulation.

LANCET (2021)

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Article Medicine, General & Internal

1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study

Lixue Huang et al.

LANCET (2021)

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Article Medicine, General & Internal

Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19

Patrick R. Lawler et al.

Summary: This study showed that therapeutic-dose anticoagulation with heparin in non-critically ill patients with Covid-19 increased the likelihood of survival to hospital discharge and reduced the need for cardiovascular or respiratory organ support compared to usual-care thromboprophylaxis.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

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Editorial Material Medicine, General & Internal

Surviving Covid-19 with Heparin?

Hugo ten Cate

NEW ENGLAND JOURNAL OF MEDICINE (2021)

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Article Medicine, General & Internal

Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19

Ewan C. Goligher et al.

Summary: In critically ill patients with Covid-19, initial therapeutic-dose anticoagulation did not result in improved survival rates or fewer days requiring cardiovascular or respiratory organ support compared to usual-care pharmacologic thromboprophylaxis.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

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Letter Hematology

Therapeutic anticoagulation in COVID-19 patients

Anna Cristina Bertoldi Lemos et al.

THROMBOSIS RESEARCH (2021)

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Review Hematology

Pathophysiology of Coagulopathy in Hematological Malignancies and in COVID-19

Marcel Levi

Summary: Severe illnesses may activate coagulation systemically, leading to a coagulopathy. While malignancies and COVID-19 display differing pathogenetic routes for coagulation abnormalities, they share the common feature of systemic impacts on coagulation. Malignancies are associated with venous thromboembolism due to tissue factor-mediated activation of coagulation, while COVID-19 induces a coagulopathy that is not identical to disseminated intravascular coagulation and thrombotic microangiopathy.

HEMASPHERE (2021)

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Article Hematology

Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia

Ning Tang et al.

JOURNAL OF THROMBOSIS AND HAEMOSTASIS (2020)

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Article Medicine, General & Internal

Clinical Characteristics of Coronavirus Disease 2019 in China

W. Guan et al.

NEW ENGLAND JOURNAL OF MEDICINE (2020)

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Article Medicine, General & Internal

Autopsy Findings and Venous Thromboembolism in Patients With COVID-19

Dominic Wichmann et al.

ANNALS OF INTERNAL MEDICINE (2020)

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Article Hematology

COVID-19 and its implications for thrombosis and anticoagulation

Jean M. Connors et al.

BLOOD (2020)

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Article Biochemistry & Molecular Biology

Inhibition of SARS-CoV-2 Infections in Engineered Human Tissues Using Clinical-Grade Soluble Human ACE2

Vanessa Monteil et al.

CELL (2020)

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Article Biochemistry & Molecular Biology

SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor

Markus Hoffmann et al.

CELL (2020)

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Letter Cardiac & Cardiovascular Systems

Pulmonary Embolism in Patients With COVID-19 Awareness of an Increased Prevalence

Julien Poissy et al.

CIRCULATION (2020)

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Article Radiology, Nuclear Medicine & Medical Imaging

Abdominal Imaging Findings in COVID-19: Preliminary Observations

Rajesh Bhayana et al.

RADIOLOGY (2020)

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Editorial Material Radiology, Nuclear Medicine & Medical Imaging

Pulmonary, Cerebral, and Renal Thromboembolic Disease in a Patient with COVID-19

Nadia Lushina et al.

RADIOLOGY (2020)

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Review Hematology

Pharmacological Agents Targeting Thromboinflammation in COVID-19: Review and Implications for Future Research

Behnood Bikdeli et al.

THROMBOSIS AND HAEMOSTASIS (2020)

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Letter Cardiac & Cardiovascular Systems

Association of Treatment Dose Anticoagulation With In-Hospital Survival Among Hospitalized Patients With COVID-19

Ishan Paranjpe et al.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2020)

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Review Cardiac & Cardiovascular Systems

COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow

Behnood Bikdeli et al.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2020)

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Article Hematology

Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy

Ning Tang et al.

JOURNAL OF THROMBOSIS AND HAEMOSTASIS (2020)

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Article Surgery

Acute limb ischemia in patients with COVID-19 pneumonia

Raffaello Bellosta et al.

JOURNAL OF VASCULAR SURGERY (2020)

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Article Medicine, General & Internal

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Fei Zhou et al.

LANCET (2020)

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Article Medicine, General & Internal

Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19

Maximilian Ackermann et al.

NEW ENGLAND JOURNAL OF MEDICINE (2020)

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Article Medicine, General & Internal

Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Covid-19

Muthiah Vaduganathan et al.

NEW ENGLAND JOURNAL OF MEDICINE (2020)

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Letter Medicine, General & Internal

Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young

Thomas J. Oxley et al.

NEW ENGLAND JOURNAL OF MEDICINE (2020)

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Article Hematology

COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection

Hanny Al-Samkari et al.

BLOOD (2020)

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Article Hematology

Postdischarge venous thromboembolism following hospital admission with COVID-19

Lara N. Roberts et al.

BLOOD (2020)

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Editorial Material Hematology

Coagulation abnormalities and thrombosis in patients with COVID-19

Marcel Levi et al.

LANCET HAEMATOLOGY (2020)

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Article Cardiac & Cardiovascular Systems

Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection

Anuradha Lala et al.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2020)

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Article Cardiac & Cardiovascular Systems

Evaluation of variation in D-dimer levels among COVID-19 and bacterial pneumonia: a retrospective analysis

Bilian Yu et al.

JOURNAL OF THROMBOSIS AND THROMBOLYSIS (2020)

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Review Medicine, General & Internal

Anticipating and managing coagulopathy and thrombotic manifestations of severe COVID-19

Lucas C. Godoy et al.

CANADIAN MEDICAL ASSOCIATION JOURNAL (2020)

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Editorial Material Oncology

COVID-19: Staging of a New Disease

Carlos Cordon-Cardo et al.

CANCER CELL (2020)

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Editorial Material Cardiac & Cardiovascular Systems

COVID-19 is, in the end, an endothelial disease

Peter Libby et al.

EUROPEAN HEART JOURNAL (2020)

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Article Cardiac & Cardiovascular Systems

Anticoagulation, Bleeding, Mortality, and Pathology in Hospitalized Patients With COVID-19

Girish N. Nadkarni et al.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2020)

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Letter Hematology

A relative ADAMTS13 deficiency supports the presence of a secondary microangiopathy in COVID 19

Nicola Martinelli et al.

THROMBOSIS RESEARCH (2020)

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Review Hematology

Is COVID-19 associated thrombosis caused by overactivation of the complement cascade? A literature review

Alexander Fletcher-Sandersjoo et al.

THROMBOSIS RESEARCH (2020)

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Article Cell Biology

Prothrombotic autoantibodies in serum from patients hospitalized with COVID-19

Yu Zuo et al.

SCIENCE TRANSLATIONAL MEDICINE (2020)

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Article Cardiac & Cardiovascular Systems

Characterization of Myocardial Injury in Patients With COVID-19

Gennaro Giustino et al.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2020)

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Article Cardiac & Cardiovascular Systems

Thromboembolic Complications in Patients With COVID-19

Gregory Piazza et al.

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2020)

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Review Rheumatology

Immune mechanisms of pulmonary intravascular coagulopathy in COVID-19 pneumonia

Dennis McGonagle et al.

LANCET RHEUMATOLOGY (2020)

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