Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines

Abstract

Coronavirus disease 2019 (COVID-19) has caused a global pandemic in just a few months, causing millions infected. Nearly 20% of COVID-19 patients present severe coagulation abnormalities, which may occur in almost all of the severe and critical ill COVID-19 cases. Concomitant venous thromboembolism (VTE), a potential cause of unexplained deaths, has been frequently reported in COVID-19 cases, but its management is still challenging due to the complexity between antithrombotic therapy and coagulation disorders. Based on frontline practical experience and comprehensive literature review, here a panel of experts and physicians from China and Europe developed an evidence and opinion-based consensus on the prophylaxis and management of VTE associated with COVID-19. This statement aims for clinicians treating COVID-19 and provides practical recommendations in detailed situations, for example, how to choose thromboprophylactic measures for patients with diverse severity of disease and bleeding risk, or which kind of anticoagulant should be prescribed. With limited experience on COVID19-associated VTE, this expert consensus statement should be helpful for clinicians worldwide with specific suggestions.

Keywords

COVID-19 - venous thromboembolism - coagulation abnormalities - prophylaxis - consensus

Expert Group Members

From Pulmonary Embolism and Pulmonary Vascular Diseases Group of the Chinese Thoracic Society, Pulmonary Embolism and Pulmonary Vascular Disease Working Committee of Chinese Association of Chest Physicians, National Cooperation Group on Prevention and Treatment of Pulmonary Embolism and Pulmonary Vascular Disease, National Capacity Building Program Office for Prevention and Treatment of Pulmonary Embolism and Deep Vein Thrombosis, China Grade Center, Evidence-based Medicine Center of School of Basic Medical Sciences of Lanzhou University.

Reviewed by

Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang) and Department of Cardiovascular Surgery and Vascular Medicine of China-Japan Friendship Hospital (Peng Liu).

Drafted by

Evidence-based Medicine Center of Lanzhou University (Yaolong Chen); China-Japan Friendship Hospital (Jun Wan, Wanmu Xie, and Zhenguo Zhai); Affiliated Hospital of Jianghan University (Chenghong Li); Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (Xiansheng Liu); the First Affiliated Hospital of Chongqing Medical University (Hong Chen); and the First Affiliated Hospital of Dalian Medical University (Yingqun Ji).

Wuhan Frontline Antiepidemic Experts

General Hospital of Northern Theater Command (Zhuang Ma); Beijing Hospital (Xiaomao Xu); Huashan Hospital Affiliated to Fudan University (Shengqing Li); the Second Hospital of Hebei Medical University (Yadong Yuan); Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (Xiansheng Liu and Jianping Zhao); Affiliated Hospital of Jianghan University (Chenghong Li and Ziyang Zhu); the First Affiliated Hospital with Nanjing Medical University (Xuesong Chen); Renmin Hospital of Wuhan University (Ke Hu); Wuhan Asia Heart Hospital (Zhenlu Zhang), Wuhan Pulmonary Hospital (Ronghui Du); Wuhan Jinyintan Hospital (Ming Wei); the Central Hospital of Wuhan (Yi Hu); the First Affiliated Hospital of Zhengzhou University (Zhe Cheng); and China-Japan Friendship Hospital (Shuai Zhang).

Discussed by

Peking University International Hospital (Shuang Liu); Peking Union Medical College Hospital (Juhong Shi); the First Affiliated Hospital of Chongqing Medical University (Hong Chen); the First Affiliated Hospital of Dalian Medical University (Yingqun Ji); the First Affiliated Hospital of Guangzhou Medical University (Chunli Liu); Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (Xiansheng Liu); the Second Hospital of Jilin University (Chunling Dong); the First Medical Center of Chinese PLA General Hospital (Weihua Zhang); Tangdu Hospital of Air Force Military Medical University (Ning Wang); Affiliated Hospital of Nantong University (Songshi Ni); the Affiliated Hospital of Qingdao University (Zhaozhong Cheng); Shandong Provincial Hospital (Ling Zhu); Ruijin Hospital Affiliated to Shanghai Jiao Tong University (Guochao Shi); Central Hospital Affiliated to Shenyang Medical College (Shuyue Xia); Shenzhen People's Hospital (Yingyun Fu); Beijing Chao-yang Hospital of Capital Medical University (Yuanhua Yang); West China Hospital of Sichuan University (Qun Yi); Shanghai Pulmonary Hospital Affiliated to Tongji University (Jinming Liu); the First Affiliated Hospital of Zhengzhou University (Jianjun Jin); Fuwai Hospital of CAMS and PUMC (Changming Xiong and Zhihong Liu); Xiangya Hospital of Central South University (Yongjun Tang); and China-Japan Friendship Hospital (Jun Wan, Wanmu Xie, Qian Gao, Yihong Sun, and Zhenguo Zhai).

Evidence Evaluated by

Beijing Hospital (Jing Wang); the First Affiliated Hospital of Chongqing Medical University (Yuliang Liu and Xiaohui Wang); Affiliated Hospital of Jianghan University (Qin Wei); Evidence-based Medicine Center of School of Basic Medical Sciences of Lanzhou University (Xuan Yu and Xufei Luo); Beijing Anzhen Hospital of Capital Medical University (Meng Zhang); and China-Japan Friendship Hospital (Kaiyuan Zhen and Zhu Zhang).

External Reviewers

General Hospital of Northern Theater Command (Lei Liu and Po Zhang); Peking University Third Hospital (Jing Zhang); Beijing Jishuitan Hospital (Yunjian Zhang); Beijing Hospital (Baomin Fang and Yongjun Li); the First Affiliated Hospital of Bengbu Medical College (Qixia Xu); Institute of Respiratory Diseases of Changsha Medical University (Aiguo Dai); the First Affiliated Hospital of Dalian Medical University (Zhonghe Zhang); the Second Affiliated Hospital of the Third Military Medical University (Ye Fan); Dongguan People's Hospital (Ruhong Xu); the First Affiliated Hospital of Fujian Medical University (Chaosheng Deng); Dongguan People's Hospital (Ping Zhang); State Key Laboratory of Respiratory Diseases of National Clinical Research Center for Respiratory Disease of Guangzhou Institute of Respiratory Health of the First Affiliated Hospital of Guangzhou Medical University (Cheng Hong, Jian Wang, and Nuofu Zhang); Guizhou Provincial People's Hospital (Weijia Liu); the First Affiliated Hospital of Henan University of Science and Technology (Yimin Mao); Key Laboratory of Respiratory Diseases of the Ministry of Health of the Department of Pathophysiology of Tongji Medical College of Huazhong University of Science and Technology (Qinghua Hu); Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (Guohua Zhen); the Second Hospital of Jilin University (Wei Xu); the Sixth Medical Center of PLA General Hospital (Yuying Li); Yan'an Hospital Affiliated to Kunming Medical University (Xiqian Xing); the First Affiliated Hospital with Nanjing Medical University (Weiping Xie); Inner Mongolia Baogang Hospital (Xiyuan Xu); Inner Mongolia People's Hospital (Jialie Wang); Shanxi Provincial People's Hospital (Aizhen Zhang); the First Hospital of Shanxi Medical University (Xiaoyun Hu and Yiwei Shi); Beijing Anzhen Hospital of Capital Medical University (Guangfa Zhu); Sichuan Provincial People's Hospital (Lu Guo); Tianjin Haihe Hospital (Qi Wu); Tianjin Medical University General Hospital (Jianlong Men and Lixia Dong); the First Affiliated Hospital of Wenzhou Medical University (Liangxing Wang); the First Affiliated Hospital of Xi'an Jiaotong University (Manxiang Li); Second People's Hospital of Tibet Autonomous Region (Wa Da); the People's Hospital of Xinjiang Uygur Autonomous Region (Ying Chen); Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region (Huiqin Yang); the First Affiliated Hospital of Xinjiang Medical University (Hui Liu); Tumor Hospital Affiliated to Xinjiang Medical University (Qin Luo); Sir Run Run Shaw Hospital Affiliated to School of Medicine of Zhejiang University (Ruifeng Zhang and Kejing Ying); the First Hospital of China Medical University (Fan Liu); and Fuwai Hospital of CAMS and PUMC (Zhihong Liu).

Note

The present consensus statement was based on its Chinese version which has been published previously in the National Medical Journal of China, 2020 March, 100(11):808–813. DOI: 10.3760/cma.j.cn112137-20200209-00227, with full permission from the journal office and the above academic groups.

^* Drs. Zhai, Li, Chen, and Elalamy contributed equally to the manuscript.

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