Questions and Answers on Practical Thrombotic Issues in SARS-CoV-2 Infectiony

A Guidance Document from the Italian Working Group on Atherosclerosis, Thrombosis and Vascular Biology

Giuseppe Patti; Veronica Lio; Ilaria Cavallari; Felice Gragnano; Letizia Riva; Paolo Calabrò; Giuseppe Di Pasquale; Vittorio Pengo; Andrea Rubboli

Disclosures

Am J Cardiovasc Drugs. 2020;20(6):559-570. 

In This Article

Abstract and Introduction

Abstract

In patients with coronavirus disease 2019 (COVID-19), the prevalence of pre-existing cardiovascular diseases is elevated. Moreover, various features, also including pro-thrombotic status, further predispose these patients to increased risk of ischemic cardiovascular events. Thus, the identification of optimal antithrombotic strategies in terms of the risk–benefit ratio and outcome improvement in this setting is crucial. However, debated issues on antithrombotic therapies in patients with COVID-19 are multiple and relevant. In this article, we provide ten questions and answers on risk stratification and antiplatelet/anticoagulant treatments in patients at risk of/with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on the scientific evidence gathered during the pandemic.

Introduction

Since December 2019, when the first cases of interstitial pneumonia were identified in the province of Wuhan, China, the infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly involved a large part of the population worldwide, reaching the global pandemic level. National health systems had to implement public health responses to protect their populations and limit viral diffusion. In patients with coronavirus disease 2019 (COVID-19), the high prevalence of cardiovascular comorbidities[1] and the increased incidence of thrombotic events, sustained by multiple factors (Figure 1), made complex and, at the same time, crucial the optimization of antithrombotic treatments. Moreover, guideline recommendations in this setting should be followed, taking into account peculiar features related to the pandemic, in particular, the modalities of transmission and the high contagiousness of SARS-CoV-2, with the related need for use of appropriate personal protective equipment and the design of specific in-hospital diagnostic and therapeutic protocols.

Figure 1.

Pathogenesis of pro-thrombotic status and thrombotic complications in patients with COVID-19. COPD chronic obstructive pulmonary disease, COVID-19 coronavirus disease 2019, DIC disseminated intravascular coagulation

In this guidance document, we provide ten questions and answers on issues related to risk stratification and antithrombotic treatments in patients at risk of/with SARS-CoV-2 infection based on the scientific evidence gathered during the pandemic.

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