Anticoagulation practice patterns in COVID‐19: A global survey
Research and Practice in Thrombosis and Haemostasis, vol. 4, pp. 969–983
Abstract
Background: Best practice for prevention, diagnosis, and management of venous thromboembolism (VTE) in patients with coronavirus disease 2019 (COVID-19) is unknown due to limited published data in this population. Objectives: We aimed to assess current global practice and experience in management of COVID-19-associated coagulopathy to identify information to guide prospective and randomized studies. Methods: Physicians were queried about their current approach to prophylaxis, diagnosis, and treatment of VTE in patients with COVID-19 using an online survey tool distributed through multiple international organizations between April 10 and 14, 2020. Results: Five hundred fifteen physicians from 41 countries responded. The majority of respondents (78%) recommended prophylactic anticoagulation for all hospitalized patients with COVID-19, with most recommending use of low-molecular-weight heparin or unfractionated heparin. Significant practice variation was found regarding the need for dose escalation of anticoagulation outside the setting of confirmed or suspected VTE. Respondents reported the use of bedside testing when unable to perform standard diagnostic imaging for diagnosis of VTE. Two hundred ninety-one respondents reported observing thrombotic complications in their patients, with 64% noting that the complication was pulmonary embolism. Of the 44% of respondents who estimated incidence of thrombosis in patients with COVID-19 in their hospital, estimates ranged widely from 1% to 50%. One hundred seventy-four respondents noted bleeding complications (34% minor bleeding, 14% clinically relevant nonmajor bleeding, and 12% major bleeding). Conclusion: Well-designed epidemiologic studies are urgently needed to understand the incidence and risk factors of VTE and bleeding complications in patients with COVID-19. Randomized clinical trials addressing use of anticoagulation are also needed.
Authors 14
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Rachel Pam Greenerger Rosovsky corresponding
Harvard University · Massachusetts General Hospital
Affiliation as printed
Department of Medicine Massachusetts General Hospital Harvard Medical School Boston MA USA
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Washington University in St. Louis · John Cochran VA Medical Center
Affiliation as printed
Department of Medicine Washington University St. Louis School of Medicine and John Cochran Veterans Administration Medical Center St. Louis MO USA
Department of Medicine, Washington University St. Louis School of Medicine and John Cochran Veterans Administration Medical Center, St. Louis, MO, USA
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The Ohio State University Wexner Medical Center · The Ohio State University
Affiliation as printed
Department of Internal Medicine Ohio State University Wexner Medical Center Columbus OH USA
Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
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University of Nebraska Medical Center
Affiliation as printed
Department of Medicine University of Nebraska Medical Center College of Medicine Memphis TN USA
Department of Medicine, University of Nebraska Medical Center College of Medicine, Memphis, TN, USA
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Affiliation as printed
Department of Medicine University of Minnesota Minneapolis MN USA
Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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Affiliation as printed
Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL USA
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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University College Dublin · Rotunda Hospital · Mater Misericordiae University Hospital
Affiliation as printed
Department of Hematology Mater Misericordiae University Hospital and Rotunda Hospital University College Dublin (UCD) School of Medicine Dublin Ireland
Department of Hematology, Mater Misericordiae University Hospital and Rotunda Hospital, University College Dublin (UCD) School of Medicine, Dublin, Ireland
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Menno Volkert Huisman Aachen Department of Thrombosis and Hemostasis Leiden University Medical Center Leiden The Netherlands Department of Thrombosis and Hemostasis
Leiden University Medical Center
Affiliation as printed
Department of Thrombosis and Hemostasis Leiden University Medical Center Leiden The Netherlands
Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
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St Thomas' Hospital · Guy's and St Thomas' NHS Foundation Trust · King's College Hospital
Affiliation as printed
Department of Haematology King's College Pathology & Rheumatology Guy's & St Thomas' NHS Foundation Trust London England
Department of Haematology, King's College, Pathology & Rheumatology, Guy's & St Thomas' NHS Foundation Trust, London, England
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Jewish General Hospital · McGill University
Affiliation as printed
Department of Medicine McGill University Montreal QC Canada
Division of Internal Medicine & Center for Clinical Epidemiology Jewish General Hospital Montreal QC Canada
Department of Medicine, McGill University, Montreal, QC, Canada
Division of Internal Medicine & Center for Clinical Epidemiology, Jewish General Hospital, Montreal, QC, Canada
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Affiliation as printed
Department of Hematology Mater University Hospital University College of Dublin (UCD) School of Medicine Dublin Ireland
Department of Hematology, Mater University Hospital, University College of Dublin (UCD), School of Medicine, Dublin, Ireland
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University of British Columbia
Affiliation as printed
Department of Medicine University of British Columbia Vancouver BC Canada
Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Affiliation as printed
National Women's Health Auckland City Hospital Auckland New Zealand
National Women's Health, Auckland City Hospital, Auckland, New Zealand
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Medical College of Wisconsin · Versiti Blood Center of Wisconsin
Affiliation as printed
Department of Medicine Blood Research Institute Versiti Medical College of Wisconsin Milwaukee WI USA
Department of Medicine, Blood Research Institute, Versiti, Medical College of Wisconsin, Milwaukee, WI, USA
Cited by 45 stored of 44
Cited by patents worldwide 2 (Lens.org)
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COVID-19-ASSOCIATED VENOUS THROMBOEMBOLISMWO2023104840A1 2023-06-15 Pending
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COVID-19-ASSOCIATED VENOUS THROMBOEMBOLISMEP4194568A1 2023-06-14 Discontinued