COVID-19 associated coagulopathy - lessons after 1 year

Jenneke Leentjens, Saskia Middeldorp, and colleagues, published a review on the current knowledge of COVID-19 associated coagulopathy and the role of antithrombotic therapies in the Lancet Haematology.

COVID-19 is associated with a high incidence of thrombotic complications, which can be explained by the complex and unique interplay between coronaviruses and endothelial cells, the local and systemic inflammatory response, and the coagulation system. Empirically, often an intensified dose of pharmacological thrombosis prophylaxis is being used in patients admitted to hospital with COVID-19. Several guidelines on this topic have been published, with varying and weak recommendations as a result of the lack of high quality and direct evidence .

In this viewpoint they summarize the pathophysiology of COVID-19 coagulopathy in the clinical context of patients, i.e. those who are ambulant, admitted to hospital (critically ill or non-critically ill), and those post-discharge from hospital. The researchers also review data from emerging randomized controlled trials in the past year of antithrombotic therapy in COVID-19 patients, and they focus on the unique international collaboration in large platform trials that have yielded the first high quality data that guide clinicians to optimize anticoagulant prophylaxis and to treat COVID-associated coagulopathy. The first-ever trial in non-critically ill patients who were admitted to hospital has shown that a therapeutic dose of low-molecular-weight heparin might improve clinical outcomes in this population. In critically ill patients, this same treatment does not improve outcomes and prophylactic dose thromboprophylaxis is recommended. In the upcoming months they expect numerous data from the ongoing antithrombotic COVID-19 studies to guide clinicians at different stages of the disease.

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