‘Practical’ guide to managing thrombosis risk, coagulopathy and DIC in COVID-19

A short practical guide for managing the risk of thrombosis and treating coagulopathies in patients with COVID-19 has been published by Thrombosis UK.

It also includes details on how to identify and treat disseminated intravascular coagulation (DIC) in patients in critical care with severe disease.

There are plans to update the guidance weekly as more evidence becomes available.

Co-author Professor Beverley Hunt, professor of thrombosis and haemostasis at King’s College London, said there had been a “noticeable absence” of guidance for managing thrombotic risk, coagulopathy and DIC prompting them to put together the straightforward “pragmatic” recommendations.

It points out that COVID-19 patients are likely to be at an increased risk of venous thromboembolism particularly if they become immobilised in critical care.

As yet it is unknown if that risk is greater than other patients hospitalised with chest infections but that thromboprophylaxis should be given to all high-risk patients as routine.

All those who are critically ill will be immobile and in an acute inflammatory state as well as the possibility of endothelial cell damage and “would benefit from intermittent pneumatic compression in addition to pharmacological thromboprophylaxis”, the guidance states.

The possibility of pulmonary thromboembolism should also be considered in patients show sudden onset of oxygen deterioration, respiratory distress and reduced blood pressure, it advises.

The recommendations, which will be updated regularly on the Thrombosis UK website, also advise switching to low molecular weight heparin in any patients with COVID-19 who were already on Warfarin or direct oral anticoagulants.

Medical reports from China describe coagulopathy in patients with COVID-19 infection who become critically ill, but the guidance stresses that “abnormal coagulation results do not require correction in patients who are not bleeding”.

The advice, which was also put together by Dr Andrew Retter, a specialist registrar in haematology at Guys and St Thomas’ NHS Foundation Trust and Dr Claire McLintock, president of the International Society on Thrombosis and Haemostasis, says that while DIC is common in intensive care, it is uncertain at this point whether there is anything unique about COVID-19 that causes DIC.

“It seems more plausible that DIC develops in patients with COVID-19 after they become hypoxic, and/or have secondary bacterial infection,” they write.

As part of a series of recommendations outlining management of DIC, it warns against the use of tranexamic acid which will inhibit the recovery process.

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