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Registry and autopsy studies of patients with COVID-19 have suggested that this infection is associated with arterial and venous thromboses in both critically and non–critically ill hospitalized patients, although the risk in outpatients is not defined. The pathophysiology underlying this clinical finding is not clear, but it may be related to both direct cytotoxic effects of the virus as well as host inflammation and coagulation abnormalities. Current guidelines suggest prophylaxis for hospitalized patients using low molecular–weight heparin or fondaparinux, and there are varying recommendations regarding post-discharge continuation. Diagnosis and treatment of thrombotic complications should be guided by clinical concern; no benefit has been observed with surveillance ultrasounds.
This article reviews the available data regarding arterial and venous thromboembolism in patients with COVID-19 and offers an algorithm for diagnostic approach, clinical management, and treatment. This is an area of active research, and ongoing findings are expected as the pandemic continues.
– Amy S. Korwin, MD
This abstract is available on the publisher's site.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with arterial and venous thrombotic complications. In a US registry of patients with coronavirus disease 2019 (COVID-19), thrombotic complications occurred in 2.6% of 229 non–critically ill hospitalized patients and in 35.3% of 170 hospitalized critically ill patients. The risk of thromboembolism in SARS-CoV-2 infection in nonhospitalized patients is unknown. Thrombotic complications include myocardial infarction (MI), ischemic stroke, and venous thromboembolism (VTE). Autopsy findings of microthrombi in multiple organ systems, including the lungs, heart, and kidneys, suggest that thrombosis may contribute to multisystem organ dysfunction in severe COVID-19.