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Role of Anticoagulant in Treatment Protocol of COVID 19 Patients
Role of Anticoagulant in Treatment Protocol of COVID 19 Patients
treatment protocol of
COVID 19 patients
: By
Amira Abdelrazek Nemr
COVID-19 has been associated with inflammation and a
prothrombotic state, with increases in fibrin, fibrin degradation
products, fibrinogen, and D-dimer levels. In some studies,
elevations in these markers have been associated with worse
.clinical outcomes
Early reports demonstrated high rates of VTE for patients who are
acutely ill or hospitalized with COVID-19, including those receiving
critical care.
The optimal strategy for thromboprophylaxis in these patients
remains uncertain.
Hypercoagulable state :
Coagulation testing
VTE
Venous thromboembolism (VTE), including extensive deep vein
thrombosis (DVT) and pulmonary embolism (PE), was very
common in acutely ill patients with COVID-19 during the early
stages of the pandemic, seen in up to one-third of patients in the
intensive care unit (ICU), even when prophylactic anticoagulation
was used .
However, there has been a general trend over time from a higher
VTE risk in hospitalized patients earlier in the pandemic towards a
lower risk later in the pandemic, although VTE risk in hospitalized
patients remains a serious concern
The reasons for the decrease in risk remain unclear; earlier
diagnosis and improved treatment may have played a role.
Clinical implications
Higher-dose anticoagulation, mostly performed using LMWH,
significantly reduced the risk of venous thromboembolic events, at
the expense of a significantly increased risk of major bleeding.
However, higher-dose anticoagulation had no effect on all-cause
death. Consequently, this meta-analysis does not support the
routine use of therapeutic-dose anticoagulation in patients
hospitalized with COVID-19. Therapeutic-dose anticoagulation
might improve outcomes in selected patients.
For patients who are at high risk for VTE and at low risk of bleeding,
extended VTE prophylaxis can be considered, as per the protocol
for patients without COVID-19.
: Reference
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432456
https://www.uptodate.com/contents/covid-19-hypercoagulability
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/
2785005