Thrombosis is major by-product of infection with COVID-19, but evidence to back full dose anticoagulation lacking

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Manj Gohel (Cambridge, UK), one of the editors-in-chief of Venous News, introduces a special COVID-19 video with leading thrombosis and haemostasis experts, including Beverley Hunt (London, UK), Ian Franklin (London, UK), Francis Matthey (London, UK) and Sriram Narayanan (Singapore), who reflect on burning questions such as what medical care can be provided by venous specialists during the pandemic; how to treat acute iliofemoral deep vein thrombosis during the pandemic and how to address the thrombosis that is a “major by-product” of COVID-19 infection.

The experts discuss the level of D-dimers in COVID-19 patients and whether or not anticoagulation should be increased as a result of elevated D-dimer levels. Hunt says that she “does not see the logic” in this approach, adding that “the horse has bolted, we are just shutting the door” and that “we need to reduce the inflammation” to reduce the thrombosis instead. Whether or not to increase anticoagulation is the “crux of the issue” adds Franklin who also looks at what level of anticoagulation is optimal after discharge to minimise the risk of thromboembolism. Meanwhile, Matthey says that “there is some debate as to whether this thrombosis is any higher than [seen with] any other serious disease” but points out that there does seem to be an incidence of venous thromboembolism of anywhere between 25% to 50% of patients “especially in those most severely ill from COVID-19”.

Narayanan highlights his own experiences in Singapore and outlines his centre’s approach to managing acute iliofemoral DVT patients during the pandemic, saying they are now more “conservative” with treatment and are deferring venous stenting until it is safe to bring patients back to the hospital.

Matthey concludes by stating that it is important that wherever possible patients are put into randomised controlled trials “so that we can get the answers because this problem is not going to go away”.

This video was filmed in April 2020 by BLearning for Venous News. Subscribe to receive BLearning videos here: www.blearning.net/registration


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