Management and Prevention of Venous Thromboembolism in Patients with COVID-19

Venous thromboembolism (VTE) is a common complication of COVID-19 infection. Throughout the COVID-19 pandemic, clinicians have faced the task of attempting to best prevent VTE while also balancing the associated risks of anticoagulation. Early in the pandemic, protocols differed by institution and clinician. This paper seeks to examine current available evidence and guidelines in order to clarify and provide recommendations on which prophylactic interventions should be used for patients, depending on the clinical scenario.

A randomized control trial (RCT) performed in 2021 revealed that critically ill patients who receive therapeutic anticoagulation do not have better outcomes than those who receive standard thromboprophylaxis. An RCT studying non-critically ill hospitalized patients revealed therapeutic anticoagulation increased organ-support free days. Study of COVID-19 outpatients reveals no clinical benefit of therapeutic or prophylactic anticoagulation.

Given these findings as well as recommendations from the American Society of Hematology, we conclude that patients who are critically ill should receive standard thromboprophylaxis, floor patients should receive therapeutic anticoagulation, and outpatients should receive neither. There is growing research in the field of treatment in VTE in COVID-19 patients. Based on the American College of Chest Physician guidelines, there are similar treatment recommendations for COVID-19 positive and negative patients diagnosed with a VTE. Due to caution regarding disease transmission and staff safety, there were not initial strong pushes toward invasive therapies and a focus was placed on medication management. With the availability of disease transmission and appropriate personal protective equipment (PPE) stocks, there is now consideration to pursue these catheter or surgical-based interventions. These recommendations may change in the future. Further research should be conducted, especially as new variants emerge and populations demonstrate increased immunity, both via vaccines and through natural infection.