CHEST Guidelines-Antithrombotic Therapy in Arterial Thrombosis and Thromboembolism in Covid-19

Antithrombotic Therapy in Arterial Thrombosis and Thromboembolism in Covid-19

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The American College of Chest Physicians' expert panel report provides guidelines for managing antithrombotic therapy in patients with COVID-19 who face arterial thrombosis and thromboembolism. Recognizing the hypercoagulable state associated with COVID-19, the panel aimed to deliver practical guidance based on existing evidence, as the current data is limited and often extrapolated from guidelines for non-COVID-19 populations.<br /><br />The panel developed recommendations through a thorough analysis of literature, using the Population, Intervention, Comparator, and Outcome (PICO) framework. Eleven recommendations were made, primarily based on indirect evidence and prior non-COVID-19 guidelines due to the overall low-quality evidence specifically available for the COVID-19 population.<br /><br />Key recommendations include maintaining existing antiplatelet therapy in patients with an indication for such treatment post-acute coronary syndrome, and continuing dual antiplatelet therapy (DAPT) for hospitalized COVID-19 patients with confirmed acute coronary syndrome (ACS) to mitigate recurrent ACS risk. However, DAPT initiation is not suggested for myocardial injury without ACS. For COVID-19 patients already on DAPT, individualized decisions should be considered if they are also on therapeutic-dose anticoagulant therapy, balancing bleeding risks.<br /><br />The report also advises against intensifying antithrombotic therapy for outpatients with prior stroke on antiplatelets. It suggests continuing current therapies with the addition of prophylactic-dose anticoagulants in hospitalized patients not in intensive care units (ICUs) and individualized considerations for those in ICUs. Acute stroke patients are advised to proceed with recanalization therapies where indicated.<br /><br />Due to sparse high-quality data, the report asserts that current management of arterial thrombosis in COVID-19 patients generally aligns with pre-pandemic guidelines, stressing the need for more targeted research to refine these strategies further. The recommendations are designed to be adaptable, reflecting the ongoing challenges in treating this multifaceted condition within the COVID-19 context.

Keywords

antithrombotic therapy

COVID-19

arterial thrombosis

thromboembolism

hypercoagulable state

guidelines

dual antiplatelet therapy

acute coronary syndrome

therapeutic-dose anticoagulant

recanalization therapies