Antithrombotic Therapy in Arterial Thrombosis and Thromboembolism in COVID-19: An American College of Chest Physicians Expert Panel Report

Tatjana Potpara*, Dominick J. Angiolillo, Behnood Bikdeli, Davide Capodanno, Oana Cole, Angel Coz Yataco, Gheorghe Andrei Dan, Stephanie Harrison, Jonathan M. Iaccarino, Lisa K. Moores, George Ntaios, Gregory Y.H. Lip

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Evidence increasingly shows that the risk of thrombotic complications in COVID-19 is associated with a hypercoagulable state. Several organizations have released guidelines for the management of COVID-19-related coagulopathy and prevention of VTE. However, an urgent need exists for practical guidance on the management of arterial thrombosis and thromboembolism in this setting. Research Question: What is the current available evidence informing the prevention and management of arterial thrombosis and thromboembolism in patients with COVID-19? Study Design and Methods: A group of approved panelists developed key clinical questions by using the Population, Intervention, Comparator, and Outcome (PICO) format that address 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 using a modified Delphi survey. Results: The review and analysis of the literature based on 11 PICO questions resulted in 11 recommendations. Overall, a low quality of evidence specific to the population with COVID-19 was found. Consequently, many of the recommendations were based on indirect evidence and prior guidelines in similar populations without COVID-19. Interpretation: The existing evidence and panel consensus do not suggest a major departure from the management of arterial thrombosis according to recommendations predating the COVID-19 pandemic. Data on the optimal strategies for prevention and management of arterial thrombosis and thromboembolism in patients with COVID-19 are sparse. More high-quality evidence is needed to inform management strategies in these patients.

Original languageEnglish
Pages (from-to)1531-1550
Number of pages20
JournalChest
Volume164
Issue number6
DOIs
StatePublished - Dec 2023
Externally publishedYes

Keywords

  • ACS/PCI
  • COVID-19
  • PAD
  • atrial fibrillation
  • limb ischemia
  • stent thrombosis
  • stroke

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