CHEST releases clinical practice guideline on antithrombotic therapy in arterial thrombosis and thromboembolism in COVID-19
June 29, 2023
Glenview, Illinois – The American College of Chest
Physicians® (CHEST) recently released a new
clinical guideline on antithrombotic therapy in arterial thrombosis and thromboembolism in COVID-19. Published in the journal CHEST®, the guideline
contains 11 evidence-based recommendations to improve risk-evaluation and to
assist in determining the course of treatment.
While there are guidelines for the
management of COVID-19-related coagulopathy for venous thromboembolism
(VTE), a recent
large cohort study
showed that COVID-19 was associated with substantially increased incidence
of both VTE and arterial thromboses, including myocardial infarction and
stroke.
“The new guideline provides recommendations for managing four arterial
(pro)thrombotic medical conditions so that when a patient presents with
COVID-19 infection either with an acute thrombotic event or a history of
them, the clinician will be able to assess the risks and benefits of
administering additional medication that may interact with a current
antithrombotic, as well as the need for modification of current
antithrombotic therapy,” says Tatjana Potpara, MD, PhD, FESC, lead author on
the guideline. “By addressing these interactions and risks in a guideline,
we can better prepare clinicians to make informed decisions on their
treatment plan and standardize care.”
The guideline includes the conditional recommendations relating to:
1) acute coronary syndrome/percutaneous coronary intervention,
2) a history of or acute stroke or transient ischemic attack,
3) previously known or newly diagnosed atrial fibrillation, and
4) peripheral artery disease/acute limb ischemia.
The recommendations include:
-
In hospitalized patients with COVID-19 and confirmed acute coronary
syndrome (ACS), we recommend dual antiplatelet therapy to reduce the
risk of recurrent ACS or death.
-
In outpatients with COVID-19 receiving antiplatelet therapy for a
previous stroke, we suggest against the addition of or change to oral or
subcutaneous anticoagulation.
-
In hospitalized patients with COVID-19, not in the ICU, receiving oral
anticoagulation for atrial fibrillation in whom the discontinuation of
oral anticoagulation is needed during hospitalization, we suggest
switching over to therapeutic dose LMWH or unfractionated heparin.
-
In hospitalized patients with COVID-19 and stable peripheral artery
disease (i.e., no acute limb events or revascularization procedures
within the past 30 days), we suggest continuation of antiplatelet
therapy if concurrent prophylactic-dose anticoagulation for COVID-19 is
being given.
The existing evidence and panel consensus do not suggest a major departure
from the management of arterial thrombosis as per pre-COVID-19
recommendations. Data on the optimal strategies for prevention and
management of arterial thrombosis and thromboembolism in patients with
COVID-19 are sparse, and more high-quality evidence is needed to inform
management strategies in these patients.
The entire list of recommendations included in the new guideline can be
accessed through the
CHEST journal website.
About the American College of Chest Physicians
The American College of Chest Physicians® (CHEST) is the global
leader in the prevention, diagnosis and treatment of chest diseases. Its
mission is to champion advanced clinical practice, education, communication
and research in chest medicine. It serves as an essential connection to
clinical knowledge and resources for its 19,000+ members from around the
world who provide patient care in pulmonary, critical care and sleep
medicine. For information about the American College of Chest Physicians,
and its flagship journal CHEST®, visit
chestnet.org.