tetano
Editor, Senior Moderator
Chest
. 2023 Jun 29;S0012-3692(23)00938-8.
doi: 10.1016/j.chest.2023.06.032. Online ahead of print. Antithrombotic therapy in arterial thrombosis and thromboembolism in COVID-19: An American College of Chest Physicians Expert Panel Report
Tatjana Potpara[SUP] 1 [/SUP], Dominick J Angiolillo[SUP] 2 [/SUP], Behnood Bikdeli[SUP] 3 [/SUP], Davide Capodanno[SUP] 4 [/SUP], Oana Cole[SUP] 5 [/SUP], Angel Coz Yataco[SUP] 6 [/SUP], Gheorghe-Andrei Dan[SUP] 7 [/SUP], Stephanie Harrison[SUP] 8 [/SUP], Jonathan M Iaccarino[SUP] 9 [/SUP], Lisa K Moores[SUP] 10 [/SUP], George Ntaios[SUP] 11 [/SUP], Gregory Y H Lip[SUP] 12 [/SUP]
Affiliations
Background: Increasing evidence shows that the risk of thrombotic complications in coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state. Several organizations have released guidelines for the management of COVID-19-related coagulopathy and prevention of venous thromboembolism. However, there is an urgent need for practical guidance on the management of arterial thrombosis and thromboembolism in this setting.
Methods: A group of approved panelists developed key clinical questions by using the PICO (Population, Intervention, Comparator, Outcome) format that addressed urgent clinical questions regarding prevention and management of arterial thrombosis and thromboembolism in patients with COVID-19. Using MEDLINE via Pubmed, a literature search was conducted and references were screened for inclusion. Data from included studies were summarized and reviewed by the panel. Consensus for the direction and strength of recommendations was achieved utilizing a modified Delphi survey.
Results: The review and analysis of the literature based on 11 PICO questions resulted in 11 recommendations. There was overall a low quality of evidence specific to the COVID-19 population. Consequently, many of the recommendations were based on indirect evidence and prior guidelines in similar populations without COVID-19.
Conclusions: The existing evidence and panel consensus do not suggest a major departure from the management of arterial thrombosis as per pre-COVID-19 recommendations. Data on the optimal strategies for prevention and management of arterial thrombosis and thromboembolism in patients with COVID-19 is sparse. More high-quality evidence is needed to inform management strategies in these patients.
Keywords: ACS/PCI; Atrial fibrillation; COVID-19; Limb ischemia; PAD; Stent thrombosis; Stroke.
. 2023 Jun 29;S0012-3692(23)00938-8.
doi: 10.1016/j.chest.2023.06.032. Online ahead of print. Antithrombotic therapy in arterial thrombosis and thromboembolism in COVID-19: An American College of Chest Physicians Expert Panel Report
Tatjana Potpara[SUP] 1 [/SUP], Dominick J Angiolillo[SUP] 2 [/SUP], Behnood Bikdeli[SUP] 3 [/SUP], Davide Capodanno[SUP] 4 [/SUP], Oana Cole[SUP] 5 [/SUP], Angel Coz Yataco[SUP] 6 [/SUP], Gheorghe-Andrei Dan[SUP] 7 [/SUP], Stephanie Harrison[SUP] 8 [/SUP], Jonathan M Iaccarino[SUP] 9 [/SUP], Lisa K Moores[SUP] 10 [/SUP], George Ntaios[SUP] 11 [/SUP], Gregory Y H Lip[SUP] 12 [/SUP]
Affiliations
- PMID: 37392958
- DOI: 10.1016/j.chest.2023.06.032
Background: Increasing evidence shows that the risk of thrombotic complications in coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state. Several organizations have released guidelines for the management of COVID-19-related coagulopathy and prevention of venous thromboembolism. However, there is an urgent need for practical guidance on the management of arterial thrombosis and thromboembolism in this setting.
Methods: A group of approved panelists developed key clinical questions by using the PICO (Population, Intervention, Comparator, Outcome) format that addressed urgent clinical questions regarding prevention and management of arterial thrombosis and thromboembolism in patients with COVID-19. Using MEDLINE via Pubmed, a literature search was conducted and references were screened for inclusion. Data from included studies were summarized and reviewed by the panel. Consensus for the direction and strength of recommendations was achieved utilizing a modified Delphi survey.
Results: The review and analysis of the literature based on 11 PICO questions resulted in 11 recommendations. There was overall a low quality of evidence specific to the COVID-19 population. Consequently, many of the recommendations were based on indirect evidence and prior guidelines in similar populations without COVID-19.
Conclusions: The existing evidence and panel consensus do not suggest a major departure from the management of arterial thrombosis as per pre-COVID-19 recommendations. Data on the optimal strategies for prevention and management of arterial thrombosis and thromboembolism in patients with COVID-19 is sparse. More high-quality evidence is needed to inform management strategies in these patients.
Keywords: ACS/PCI; Atrial fibrillation; COVID-19; Limb ischemia; PAD; Stent thrombosis; Stroke.