Prevention of Thromboembolic Events in Patients with COVID-19.

Abstract

The novel coronavirus disease 2019 (COVID-19)-associated coagulopathy is a known cause of signi fi cant morbidity and mortality in patients affected by coronavirus. The proposed pathogenesis of hypercoagulability in COVID-19 patients is attributed to Virchow ’ s Triad, wherein hypoxia, severe in-fl ammation, and cytokine storm cause endothelial injury, activation of the coagulation cascade, and immobilization in critically ill patients, all contribute to increased risk of thrombosis. 1 Patients requiring intensive care unit (ICU) admission have increased risk of thrombosis despite standard dose of thromboprophylaxis. 2 – 4 COVID-19 treatment has focused on targeting the unregulated in fl ammatory state to decrease incidence of COVID-19-related complications, including thrombosis. Due to increased risk of thromboembolism, prophylactic anticoagulation is recommended in all hospitalized COVID-19 patients and intermediate to therapeutic dosing is sug-gested in patients with severe COVID-19, such as those requiring ICU admission. 5,6 In addition tohypercoagulability, COVID-19 patients are also at an increased risk for bleeding events due to variance in platelet production and destruc-tion, consumption of coagulation factors in the setting of severe in fl ammation, increased exposure to and dosing of anticoagulation