Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine.
Grigorios T GerotziafasMariella CatalanoMary-Paula ColganZsolt PecsvaradyJean Claude WautrechtBahare FazeliDan-Mircea OlinicKatalin FarkasIsmail ElalamyAnna FalangaJawed FareedChryssa PapageorgiouRosella S ArellanoPetros AgathagelouDarco AnticLuciana AuadLjiljana BanficJohn R BartolomewBela BenczurMelissa B BernardoFrancesco BoccardoRenate CifkovaBenilde CosmiSergio De MarchiEvangelos DimakakosMeletios A DimopoulosGabriel DimitrovIsabelle Durand-ZaleskiMichael EdmondsEssam Abo El NazarDilek ErerOmar L EspondaPaolo GreseleMichael GschwandtnerYongquan GuMónica HeinzmannNaomi M HamburgAmer HamadéNoor-Ahmed JatoiOguz KarahanDebora KaretovaThomas KarplusPeter Klein-WeigelEndre KolossvaryMatija KozakEleftheria LefkouGianfranco LessianiAaron LiewAntonella MarcocciaPeter MarshangGeorge MarakomichelakisJiri MatuskaLuc MoragliaSergio PillonPavel PoredosManlio PriorDavid Raymund K SalvadorOliver SchlagerGerit SchernthanerAlexander SieronJonas SpaakAlex SpyropoulosMuriel SpryngerDusan SuputAgata StanekViera StvrtinovaAndrzej SzubaAlfonso TafurPatrick VandredenPanagiotis E VardasDragan VasicMiikka VikkulaPaul WennbergZhenguo Zhainull nullPublished in: Thrombosis and haemostasis (2020)
COVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH.
Keyphrases
- venous thromboembolism
- direct oral anticoagulants
- cardiovascular risk factors
- coronavirus disease
- sars cov
- cardiovascular disease
- metabolic syndrome
- healthcare
- risk assessment
- risk factors
- atrial fibrillation
- respiratory syndrome coronavirus
- mental health
- end stage renal disease
- chronic kidney disease
- physical activity
- coronary artery
- drug delivery
- weight gain
- adipose tissue
- peritoneal dialysis
- newly diagnosed
- drug induced
- growth factor