Evidence-Based Practical Guidance for the Antithrombotic Management in Patients With Coronavirus Disease (COVID-19) in 2020

This practical guidance, endorsed by the Brazilian Society of Thrombosis and Hemostasis and The Brazilian Society of Angiology and Vascular Surgery, the International Union of Angiology and the European Venous Forum, aims to provide physicians with clear guidance, based on current best evidence-based data, on clinical strategies to manage antithrombotic strategies in patients with coronavirus disease 2019.

Coronavirus disease 2019 (COVID-19) predispose patients to arterial and venous thrombotic complications due to its endothelial dysfunction and interplay with intense inflammation, platelet activation, and stasis. Also, many patients receiving antithrombotic therapy for venous or arterial thrombotic disease may develop COVID-19 or have its anticoagulation strategy affected by the pandemic crisis. A fair number of guidelines and statement documents were rapidly published and, unfortunately, given the urgent nature of the pandemic, many proposing some never-evaluated anticoagulation/thrombosis management strategies. In this practical guide, we review the current understanding of the pathogenesis, evolving epidemiology and propose an evidence-based management strategy for patients with COVID-19 who develop venous or arterial thrombosis, and of those with preexisting cardiovascular disease who develop COVID-19, or those who need their antithrombotic regimens to be managed during the COVID-19 pandemic. The objective is to keep this guidance very practical, highlighting the knowledge gaps and areas of uncertainty where randomized clinical trials (RCTs) are desperately needed.