Prophylactic anticoagulation for patients in hospital with covid-19
Beverley J. Hunt, Erich Vinícius De Paula, Claire McLintock, Mert Dumantepe
Abstract
Most people with covid-19 have mild disease, but after 5-10 days an important minority develop pneumonia and require hospital admission to treat hypoxia.This group is in a marked prothrombotic state and has high rates of hospital associated venous thromboembolism. 1 Early in the pandemic, deep vein thromboses and high rates of occlusive changes on computed tomography pulmonary angiograms were seen in at least 70% of patients with severe covid-19.Although these were initially thought to be pulmonary emboli, many patients had only isolated segmental and subsegmental changes, probably caused by the in situ thrombosis (termed immunothrombosis) that occurs in all forms of acute respiratory distress syndrome, 2 3 although more commonly with covid-19. 4 5 Randomised controlled trials show that drug based thromboprophylaxis with low molecular weight heparin (LMWH) reduces the risk of hospital associated venous thromboembolism by about 50% in medical and critically ill inpatients. 6 Risk factors that qualify patients for thromboprophylaxis are reduced mobility; acute infective illness, such as pneumonia; and admission for critical care.Thus, adults admitted to hospital with covid-19 pneumonia should automatically receive thromboprophylaxis.