CHEST Guidelines-Antithrombotic-Therapy-in-Arterial-Thrombosis-and-

Antithrombotic-Therapy-in-Arterial-Thrombosis-and-

Pdf Summary

The American College of Chest Physicians' Expert Panel Report focuses on antithrombotic therapy for arterial thrombosis and thromboembolism in COVID-19 patients. The document highlights the increased thrombotic risks associated with COVID-19 and lays out recommendations for managing these complications, despite limited high-quality evidence specific to COVID-19. It examines antiplatelet and anticoagulant therapies and considers their application within various scenarios involving arterial thrombosis during COVID-19.<br /><br />The panel's findings suggest that existing evidence does not significantly deviate from pre-pandemic guidelines for managing arterial thrombosis. Eleven recommendations were formulated based on a modified Delphi consensus survey, largely reflecting practices established before COVID-19, due to low-quality evidence specific to the COVID-19 population. Highlights from the recommendations include:<br /><br />1. For patients hospitalized with COVID-19 who have a prior indication for antiplatelet therapy due to an ACS, continuing current therapy is suggested.<br />2. In confirmed ACS cases during hospitalization, dual antiplatelet therapy (DAPT) is strongly recommended to mitigate recurrent ACS risk.<br />3. Initiation of DAPT is not recommended for patients presenting with myocardial injury absent of ACS.<br />4. For stroke prevention in patients with pre-existing Atrial Fibrillation (AF), transitioning to heparin from oral anticoagulation is advised during hospitalization if necessary.<br /><br />The panel advises against routine antithrombotic therapy intensification based on COVID-19 diagnosis alone, stressing that decisions should be individualized, particularly considering bleeding risks. Further high-quality research is called for to refine guidelines and improve evidence-based practice, focusing on thrombotic complications as COVID-19 evolves.<br /><br />Overall, this report reinforces adhering to existing guidelines enhanced with specific COVID-19 considerations, emphasizing the need for individualized patient assessment and treatment balancing thrombotic and bleeding risks effectively.

Keywords

antithrombotic therapy

arterial thrombosis

COVID-19

thromboembolism

antiplatelet therapy

anticoagulant therapy

Delphi consensus

dual antiplatelet therapy

Atrial Fibrillation

thrombotic risks