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News & Press: ISTH News

A Systematic Approach for Managing Venous Thromboembolism in Patients with COVID-19

Wednesday, July 15, 2020   (0 Comments)
Posted by: Andy Masten
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A Systematic Approach for Managing Venous Thromboembolism in Patients with COVID-19: A Multinational Consensus Statement from the International Society on Thrombosis and Haemostasis (ISTH) on Behalf of the International Thrombosis Community

Introduction

With more than 6.7 million confirmed cases worldwide[i] and nearly 400,000 deaths to date (7th June 2020) during 2020,[ii] the COVID-19 pandemic is one of the most significant healthcare crises of our time. The spread of COVID-19 has been varied, with some regions having sporadic transmission and relatively few hospitalized patients with COVID-19 pneumonia, and others where significant transmission has overwhelmed health services. While the disruption to health services continues, it is vital for the World Health Organization (WHO) to share the lessons of how best to prevent, diagnose, and treat patients with COVID-19 with health systems globally, and to learn about agreed clinical best practice approaches, which may improve patient outcomes.

The WHO should be congratulated on the publication of interim guidance on the Clinical Management of hospitalized patients with COVID-19[iii], the second iteration of which was published by the WHO in late May, which serves as a useful first step resource for health systems internationally. However, more must be done to meet the needs of front-line clinicians caring for patients with COVID-19 to ensure quality care, by addressing significant gaps in expert clinical guidance surrounding the prevention and management of venous thromboembolism (VTE) in COVID-19 patients.

COVID-19 and Venous Thromboembolism (VTE)

Venous thromboembolism (VTE) is a condition in which a blood clot forms most often in the deep veins of the leg, groin or arm (known as deep vein thrombosis , DVT) and travels in the circulation, lodging in the lungs (known as pulmonary embolism, PE). Together, DVT and PE are known as VTE - a dangerous, potentially deadly, medical condition.[iv] Hospital-associated VTE (describes VTE occurring in hospital and 90 days post discharge) accounts for 60% of all VTE.

Emerging research indicates that:

  • People with COVID-19, especially those hospitalized with the moderate (requiring supplementary oxygenation) and severe (requiring mechanical ventilation) COVID-19 pneumonia have a high incidence of VTE[v]
  • COVID-19 pneumonia is associated with a marked hypercoagulability, including high levels of fibrinogen and very high D-dimer levels;
  • In patients with COVID-19 pneumonia, there is a major inflammatory response which can lead to micro-clots – immunothrombosis - within the lungs. This likely contributes to the high levels of mortality seen in patients with COVID-19 pneumonia;
  • Some countries are facing difficulties in accessing low molecular weight heparins (blood thinners), a WHO essential medicine, that is a vital prophylactic and treatment for VTE in hospitalized patients with COVID-19.

Call to Action on WHO in Relation to COVID-19-Related VTE

To reduce harm from COVID-19 associated VTE, the International Society on Thrombosis and Haemostasis, together with the undersigned national, continental and international clinical representative organizations, urgently calls on the WHO to endorse and share the application of a system-wide approach to VTE management on a global scale, as part of the international COVID-19 response that seeks to:

  • Highlight the importance of a systematic approach to VTE prevention, diagnosis and treatment for patients with COVID-19; including those isolating at home, those hospitalized and those post discharge;
  • Meet the needs of front-line clinicians caring for patients with COVID-19 to ensure quality care by improving health worker education about VTE in COVID-19 management that incorporates up-to-date consensus recommendations in the next iterations of WHO interim guidance on the Clinical Management of COVID-19 (ensuring a VTE expert(s) is enlisted to the Guideline Development Group);
  • Signpost hospitals to accredited up-to-date evidence based clinical information portals on VTE related COVID-19 clinical guidance, such as the ISTH COVID-19 Resource Page;
  • Highlight to member states the importance of making available all WHO Essential Medicines, in particular low molecular weight heparins (blood thinners), which provides vital prophylactic and treatment for VTE;
  • Improve COVID-19 VTE data collection and research to support regular updates of evidence-based clinical recommendations; and
  • Encourage the implementation of a global VTE risk assessment tool for hospitalized patients.

VTE not only can kill, but can also have devastating co-morbidities, which significantly impact the quality of life for patients who survive COVID-19 and an associated VTE[vi] .

Until there is a vaccine for COVID-19, there is no better way to address this public health challenge than for the WHO to prioritize the development of systematic and integrated approaches to COVID-19-related VTE prevention that can be implemented in secondary and tertiary settings globally.

We urge the WHO to act now and offer our collective resources and expertise to assist in such an endeavor.

 

Signed on behalf of ISTH

 

Claire McLintock                            Jeffrey Weitz                                    Beverley Hunt, O.B.E.

President                                          President-Elect                               Chair, World Thrombosis Day

     
     

 

 

Aktionsbündnid Thrombose

 


American Heart Association


American Society of Hematology


Anticoagulation Forum

 


 

 

APS Foundation of America

 


 

Armenian Association of Hematology and Oncology


 

 

Armenian Association of Hemophilia


 

Armenian Hematology Association


Asian Pacific Society of Cardiology

 


 

Asian Pacific Society of Thrombosis and Haemostasis

 


 

Asociación Peruana de Trombosis y Hemostasia


Associazione per la Lotta alla Trombosi ealle malattie cardiovascolari – Onlus

 

 

Belgian Society on Thrombosis and Haemostasis



Brazilian Association of Hematology, Hemotherapy and

Cell Therapy


Brazilian Society on Thrombosis and Haemostasis

 

Canadian Venous Thromboembolism Research Network

Centre of Excellence in Thrombosis and Anticoagulation Care

Clinical Leaders of Thrombosis

 

 

 

ČSTH ČLS JEP, Česká společnost pro trombózu a hemostázu ČLS JEP

Deutsche Gefäßliga e.V.


Deutschen Gesellschaft für Gefäßchirurgie und Gefäßmedizin


Deutschen Gesellschaft für Phlebologie

Dutch Society for Thrombosis and Haemostasis

European Thrombosis & Haemostasis Alliance

European Association for Haemophilia and Allied Disorders

 

Gesellschaft für Thrombose- und Hämostaseforschung

Global Innovative Foundation For Transforming Society (GIFTS NGO)

 

Grupo Cooperativo Latino Americano de Hemostasia y Trombosis

Health First Europe

Hospital de Clínicas, Facultad de Medicina, Universidad de la República

Hungarian Society of Thrombosis and Haemostasis

International Society on Thrombosis and Haemostasis

Institute for the Study and Education on Thrombosis and Antithrombotic Therapy

Iranian Association for Hemophilia and Thrombophilia

Japanese Society on Thrombosis and Hemostasis

 

Kenya Society on Thrombosis and Haemostasis (KSTH)

            

Korean Society on Thrombosis and Haemostasis

Kyrgyz Society of Cardiology

Lithuanian Heart Association

Macedonian Society for Transfusion Medicine

Moroccan Society of
Vascular Diseases

National Blood Clot Alliance

Norwegian Society on Thrombosis and Haemostasis

 

PERT Consortium

 

   

Preventative Cardiovascular Nurses Association

 

Romanian Society for Vascular Surgery

 

Romanian Society of Hemostasis and Thrombosis


Russian National Association on Thrombosis and Hemostasis

                

Russian Scientific Inflammation Society

 

Slovak Society on Haemostasis and Thrombosis

        

Sociedad de Hematología del Uruguay

 

Sociedad de Medicina Interna del Uruguay

Sociedad Espanola de Trombosis y Hemostasia

 

Sociedad Uruguaya de Patología Clínica

Società Italiana per lo Studio dell’Emostasi e della Trombosi (SISET)

 

South Asian Society on Atherosclerosis and Thrombosis

Stroke Association of Ghana

Swedish Society on Thrombosis and Haemostasis

 

Swiss Society of Hematology

 

Thai Society of Hematology