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Thromb Haemost 2020; 120(12): 1597-1628
DOI: 10.1055/s-0040-1715798
Position Paper

Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine

Grigoris T. Gerotziafas 
1   Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France
2   Research Group Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
,
Mariella Catalano
3   Research Center on Vascular Disease & Angiology Unit, Department of Biomedical Science, L Sacco Hospital, University of Milan, Milan, Italy
,
Mary-Paula Colgan
4   Department of Vascular Surgery, St. James's Hospital/Trinity College Dublin, Dublin, Ireland
,
Zsolt Pecsvarady
5   Department of Vascular Medicine, Flor Ferenc Teaching Hospital, Kistarcsa, Hungary
,
Jean Claude Wautrecht
6   Service de Pathologie Vasculaire, Hôpital ERASME, Université Libre de Bruxelle, Brussels, Belgium
,
Bahare Fazeli
7   Immunology Department, Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Sciences, Iran
,
Dan-Mircea Olinic
8   Medical Clinic No. 1, University of Medicine and Pharmacy, Cluj-Napoca, Romania
,
Katalin Farkas
9   Department of Angiology, St. Imre University Teaching Hospital, Budapest, Hungary
,
Ismail Elalamy
1   Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France
2   Research Group Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
10   Department of Obstetrics and Gynecology, I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
,
Anna Falanga
11   Department of Immunohematology and Transfusion Medicine, & the Thrombosis and Hemostasis Center, Hospital Papa Giovanni XXIII, Bergamo, Italy
,
Jawed Fareed
12   Department of Pathology, Loyola University Medical Center, Maywood, Illinois, United States
,
Chryssa Papageorgiou
13   Service Anesthésie, Réanimation et Médecine Périopératoire, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de médecine, Sorbonne Université, Paris, France
,
Rosella S. Arellano
14   Philippine Society of Vascular Medicine, Manila, Philippine
,
Petros Agathagelou
15   Department of Inrterventional Cardiology, American Heart Institute of Cyprus, Nicosia, Cyprus
,
Darco Antic
16   Clinic for Hematology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
,
Luciana Auad
17   Medicina Vascular, Sanatorio Allende Córdoba, Ciencias Médicas, Universidad Católica de Córdoba, Argentina
,
Ljiljana Banfic
18   University Hospital Center, School of Medicine University of Zagreb, Croatia
,
John R. Bartolomew
19   Cleveland Clinic, Cleveland, Ohio, United States
,
Bela Benczur
20   Balassa Janos County Hospital, University Medical School, Szeged, Hungary
,
Melissa B. Bernardo
14   Philippine Society of Vascular Medicine, Manila, Philippine
,
Francesco Boccardo
21   Department of Cardio-Thoracic-Vascular and Endovascular Surgery, Unit of Lymphatic Surgery, IRCCS S. Martino Hospital, University of Genoa, Italy
,
Renate Cifkova
22   Department of Preventive Cardiology, Thomayer Teaching Hospital, Prague, Czech Republic
,
Benilde Cosmi
23   Angiology and Blood Coagulation, Department of Specialty, Diagnostic and Experimental Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
,
Sergio De Marchi
24   Angiology Unit, Cardiovascular and Thoracic and Medicine Department, Verona University Hospital, Verona, Italy
,
Evangelos Dimakakos
25   Vascular Unit of 3rd Department of Internal Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
,
Meletios A. Dimopoulos
26   Hellenic Society of Hematology, Athens, Greece
27   Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
,
Gabriel Dimitrov
3   Research Center on Vascular Disease & Angiology Unit, Department of Biomedical Science, L Sacco Hospital, University of Milan, Milan, Italy
,
Isabelle Durand-Zaleski
28   Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l'Hôtel Dieu, Paris, France
,
Michael Edmonds
29   Diabetic Foot Clinic, King's College Hospital, London, United Kingdom
,
Essam Abo El Nazar
30   Departement of Surgery, Ministry of Health, Saudi Arabia
,
Dilek Erer
31   Department of Cardiovascular Surgery, Faculty of Medicine, Gazi University, Besevler/Ankara, Turkey
,
Omar L. Esponda
32   Internal Medicine Department, Hospital Perea, Mayaguez, Puerto Rico, United States
,
Paolo Gresele
33   Section of Internal and Cardiovascular Medicine, Department of Medicine, -University of Perugia, Perugia, Italy
,
Michael Gschwandtner
34   MedizinischeUniverstiät Wien, Universitätsklinik für Innere Medizin II, Klinische Abteilung für Angiologie, Vienna, Austria
,
Yongquan Gu
35   Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing China
,
Mónica Heinzmann
17   Medicina Vascular, Sanatorio Allende Córdoba, Ciencias Médicas, Universidad Católica de Córdoba, Argentina
,
Naomi M. Hamburg
36   The Whitaker Cardiovascular Institute Department of Medicine Boston University School of Medicine, Boston, Massachusetts, United States
,
Amer Hamadé
37   Vascular Medicine Unit, Internal Medicine Department, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
,
Noor-Ahmed Jatoi
38   Department Vascular Medicine, Mulhouse Hospital Center, Mulhouse, France
,
Oguz Karahan
39   Department of Cardiovascular Surgery, Medical School of Alaaddin Keykubat University, Alanya/Antalya, Turkey
,
Debora Karetova
40   Second Department of Medicine, Department of Cardiovascular Medicine, Charles University in Prague, Prague, Czech Republic
,
Thomas Karplus
41   Department of Vascular Medicine, Concord Repatriation General Hospital, Sydney, Australia
,
Peter Klein-Weigel
42   Klinik für Angiologie, Zentrum für Innere Medizin II, Ernst von Bergmann Klinikum, Potsdam, Germany
,
Endre Kolossvary
9   Department of Angiology, St. Imre University Teaching Hospital, Budapest, Hungary
,
Matija Kozak
43   Department for Vascular Diseases, Medical Faculty of Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia
,
Eleftheria Lefkou
44   Board member of the Institute for the Study and Education on Thrombosis and Antithrombotic Therapy, Athens, Greece
,
Gianfranco Lessiani
45   Angiology Unit, Internal Medicine Department., Città Sant' Angelo Hospital, AUSL 03, Pescara, Italy
,
Aaron Liew
46   Portiuncula University Hospital, Soalta University Health Care Group, National University of Ireland Galway (NUIG), Galway, Ireland
,
Antonella Marcoccia
47   Unità di Medicina Vascolare e Autoimmunità, CRIIS-Centro di riferimento interdisciplinare per la Sclerosi Sistemica, Rome, Italy
,
Peter Marshang
48   Department of Internal Medicine, Central Hospital of Bolzano, Bolzano, Italy
,
George Marakomichelakis
49   Angiology Unit, Evangelismos General Hospital, Athens, Greece
,
Jiri Matuska
50   MATMED s.r.o., Private Angiology Facility, Hodonin, Czech Republic
,
Luc Moraglia
51   Angiologie Centre Cours du Médoc, Médecine Vasculaire Travail, Bordeaux, France
,
Sergio Pillon
52   UOSD Angiology, San Camillo-Forlanini Hospital, National Health Institute ISS, Rome, Italy
,
Pavel Poredos
53   Medical Association of Slovenia and SMA, Slovenia Academic Research Centre, Slovenian Medical Academy, Ljubljana, Slovenia
,
Manlio Prior
54   Angiology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
,
David Raymund K. Salvador
14   Philippine Society of Vascular Medicine, Manila, Philippine
,
Oliver Schlager
55   Division of Angiology, Department of Internal Medicine 2, Medical University of Vienna, Vienna, Austria
,
Gerit Schernthaner
55   Division of Angiology, Department of Internal Medicine 2, Medical University of Vienna, Vienna, Austria
,
Alexander Sieron
56   Department of Internal Medicine, Angiology and Physical Medicine, Medical University of Silesia, Katowice, Poland
57   Specialist Hospital, Bytom, Jan Długosz University in Częstochowa, Częstochowa, Poland
,
Jonas Spaak
58   Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Stockholm County, Sweden
,
Alex Spyropoulos
59   Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Feinstein Institute for Medical Research, New York, New York, United States
,
Muriel Sprynger
60   Cardiology Department, University Hospital Sart Tilman, Liege, Belgium
,
Dusan Suput
61   Center for Clinical Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
,
Agata Stanek
62   Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Bytom, Poland
,
Viera Stvrtinova
63   Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
,
Andrzej Szuba
64   Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland
,
Alfonso Tafur
65   Vascular Medicine University of Chicago, Northshore Cardiovascular Institute, Skokie, Illinois, US Army
,
Patrick Vandreden
2   Research Group Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France
,
Panagiotis E. Vardas
66   Medical School of Crete, University of Crete and Heart Sector, Hellenic Healthcare Group, Athens, Greece
,
Dragan Vasic
67   Department of Noninvasive vascular laboratory, Clinic of Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia
,
Miikka Vikkula
68   Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
,
Paul Wennberg
69   Department of Cardiovascular Medicine, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, United States
,
Zhenguo Zhai
70   Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Peking University Health Science Center, Capital Medical University, Beijing, China
71   Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
,
Scientific Reviewer Committee
› Author Affiliations Funding None.
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Abstract

COVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH.

Keywords

COVID-19 - cardiovascular disease - peripheral artery disease - deep vein thrombosis - antithrombotic - antiplatelets - anticoagulants - low-molecular-weight heparin - DOAC


Publication History

Received: 28 May 2020

Accepted: 23 July 2020

Article published online:
13 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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