Thromb Haemost. Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines

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Thromb Haemost. 2020 Apr 21. doi: 10.1055/s-0040-1710019. [Epub ahead of print]
Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines.


Zhai Z^#1,2,3, Li C^#4, Chen Y^#5, Gerotziafas G⁶, Zhang Z⁷, Wan J^1,2,3, Liu P⁸, Elalamy I^6,9, Wang C^1,2,3,10; Prevention Treatment of VTE Associated with COVID-19 Infection Consensus Statement Group, Pulmonary Embolism Pulmonary Vascular Diseases Group of the Chinese Thoracic Society, Pulmonary Embolism Pulmonary Vascular Disease Working Committee of Chinese Association of Chest Physicians, National Cooperation Group on Prevention Treatment of Pulmonary Embolism Pulmonary Vascular Disease, National Program Office for Prevention Treatment of Pulmonary Embolism Deep Vein Thrombosis, China Grade Center, Evidence-based Medicine Center of School of Basic Medical Sciences of Lanzhou University.

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Abstract

Coronavirus disease 2019 (COVID-19) has caused a global pandemic in just a few months, causing millions infected. Nearly 20% of COVID-19 patients present severe coagulation abnormalities, which may occur in almost all of the severe and critical ill COVID-19 cases. Concomitant venous thromboembolism (VTE), a potential cause of unexplained deaths, has been frequently reported in COVID-19 cases, but its management is still challenging due to the complexity between antithrombotic therapy and coagulation disorders. Based on frontline practical experience and comprehensive literature review, here a panel of experts and physicians from China and Europe developed an evidence and opinion-based consensus on the prophylaxis and management of VTE associated with COVID-19. This statement aims for clinicians treating COVID-19 and provides practical recommendations in detailed situations, for example, how to choose thromboprophylactic measures for patients with diverse severity of disease and bleeding risk, or which kind of anticoagulant should be prescribed. With limited experience on COVID19-associated VTE, this expert consensus statement should be helpful for clinicians worldwide with specific suggestions.
Georg Thieme Verlag KG Stuttgart ? New York.



PMID:32316065DOI:10.1055/s-0040-1710019

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"It's very striking how much this disease causes clots to form," Dr. J Mocco, a Mount Sinai neurosurgeon, said in an interview, describing how some doctors think Covid-19, the illness caused by the coronavirus, is more than a lung disease. In some cases, Mocco said, a stroke was a young patient's first symptom of Covid-19.

As colleagues from various specialties pooled their observations, they developed a new treatment protocol. Patients now receive high doses of a blood-thinning drug even before any evidence of clotting appears.

"Maybe, just maybe, if you prevent the clotting, you can make the disease less severe," said Dr. David Reich, the hospital president. The new protocol will not be used on certain high-risk patients because blood thinners can lead to bleeding in the brain and other organs.
"FUNNY YOU MENTIONED THAT"


In the three weeks beginning mid-March, Mocco saw 32 stroke patients with large blood blockages in the brain, double the usual number for that period.

Five were unusually young, under age 49, with no obvious risk factors for strokes, "which is crazy," he said. "Very, very atypical." The youngest was only 31.

At least half of the 32 patients would test positive for Covid-19, Mocco said.

Meanwhile, Dr. Hooman Poor, a Mount Sinai lung specialist, found himself working a late shift with 14 patients on ventilators. The ventilator readings were not what he expected.

The lungs did not seem stiff, as is common in pneumonia. Instead, it seemed blood was not circulating freely through the lungs to be aerated with each breath.