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Anticoagulation practice patterns in COVID-19: A global survey Open Access (recommended)


Resource type(s)
blood coagulation
venous thromboembolism
Attribution-NonCommercial-NoDerivs 3.0 United States

Rosovsky, Rachel
Sanfilippo, Kristen M.
Wang, Tzu Fei
Rajan, Sandeep K.
Shah, Surbhi
Martin, Karlyn A
Ni Ainle, Fionnuala
Huisman, Menno
Hunt, Beverley J.
Kahn, Susan R.
Kevane, Barry
Lee, Agnes Y. Y.
McLintock, Claire
Kreuziger, Lisa Baumann
Background Best practice for prevention, diagnosis, and management of venous thromboembolism (VTE) in patients with coronavirus disease 2019 (COVID-19) is unknown due to limited published data in this population. Objectives We aimed to assess current global practice and experience in management of COVID-19-associated coagulopathy to identify information to guide prospective and randomized studies. Methods Physicians were queried about their current approach to prophylaxis, diagnosis, and treatment of VTE in patients with COVID-19 using an online survey tool distributed through multiple international organizations between April 10 and 14, 2020. Results Five hundred fifteen physicians from 41 countries responded. The majority of respondents (78%) recommended prophylactic anticoagulation for all hospitalized patients with COVID-19, with most recommending use of low-molecular-weight heparin or unfractionated heparin. Significant practice variation was found regarding the need for dose escalation of anticoagulation outside the setting of confirmed or suspected VTE. Respondents reported the use of bedside testing when unable to perform standard diagnostic imaging for diagnosis of VTE. Two hundred ninety-one respondents reported observing thrombotic complications in their patients, with 64% noting that the complication was pulmonary embolism. Of the 44% of respondents who estimated incidence of thrombosis in patients with COVID-19 in their hospital, estimates ranged widely from 1% to 50%. One hundred seventy-four respondents noted bleeding complications (34% minor bleeding, 14% clinically relevant nonmajor bleeding, and 12% major bleeding). Conclusion Well-designed epidemiologic studies are urgently needed to understand the incidence and risk factors of VTE and bleeding complications in patients with COVID-19. Randomized clinical trials addressing use of anticoagulation are also needed.
Original Bibliographic Citation
Rosovsky RP, Sanfilippo KM, Wang TF, Rajan SK, Shah S, Martin KA, Ainle FN, Huisman M, Hunt BJ, Kahn SR, Kevane B, Lee AYY, McLintock C, Kreuziger LB. Anticoagulation practice patterns in COVID-19: A global survey. Research and Practice in Thrombosis and Haemostasis. 2020;4(6):969-983.
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(PMID) 32838111
Subject: MESH
Blood Coagulation
Venous Thromboembolism
Subject: LCSH
COVID-19 (Disease)
The authors thank the Hemostasis and Thrombosis Research Society, Venous thromboEmbolism Network United States, Latin American Cooperative Group for Hemostasis and Thrombosis, Unit for Thrombosis and Hemostasis at the Hospital de Clnicas in Uruguay, and the Mexican Society of Thrombosis and Hemostasis, the Asia Pacific Society of Thrombosis and Haemostasis, the Thrombosis and Haemostasis Society of Australia and New Zealand, the Irish Network for VTE Research, and the International Society on Thrombosis and Haemostasis for support of the survey.
Grants and funding
Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1-TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr Kahn is a Tier 1 Canada Research Chair holder, and an investigator of the CanVECTOR Network, which receives grant funding from the Canadian Institutes of Health Research (Funding Reference: CDT-142654).

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