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

Grigoris T. Gerotziafas, Mariella Catalano, Mary-Paula Colgan, Zsolt Pecsvarady, Jean Claude Wautrecht, Bahare Fazeli, Dan-Mircea Olinic, Katalin Farkas, Ismail Elalamy, Anna Falanga11 Jawed Fareed, Chryssa Papageorgiou, Rosella S. Arellano, Petros Agathagelou, Darco Antic, Luciana Auad, Ljiljana Banfic, John R. Bartolomew, Bela Benczur, Melissa B. Bernardo, Francesco Boccardo, Renate Cifkova, Benilde Cosmi, Sergio De Marchi, Evangelos Dimakakos, Meletios A. Dimopoulos, Gabriel Dimitrov, Isabelle Durand-Zaleski, Michael Edmonds, Essam Abo El Nazar, Dilek Erer, Omar L. Esponda, Paolo Gresele, Michael Gschwandtner, Yongquan Gu, Mónica Heinzmann, Naomi M. Hamburg, Amer Hamadé, Noor-Ahmed Jatoi, Oguz Karahan, Debora Karetova, Thomas Karplus, Peter Klein-Weigel, Endre Kolossvary, Matija Kozak, Eleftheria Lefkou, Gianfranco Lessiani, Aaron Liew, Antonella Marcoccia, Peter Marshang, George Marakomichelakis, Jiri Matuska, Luc Moraglia, Sergio Pillon, Pavel Poredos, Manlio Prior, David Raymund K. Salvador, Oliver Schlager, Gerit Schernthaner, Alexander Sieron, Jonas Spaak, Alex Spyropoulos, Muriel Sprynger, Dusan Suput, Agata Stanek, Viera Stvrtinova, Andrzej Szuba, Alfonso Tafur, Patrick Vandreden, Panagiotis E. Vardas, Dragan Vasic, Miikka Vikkula, Paul Wennberg, Zhenguo Zhai, Scientific Reviewer Committee


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.

Keywords: COVID-19, cardiovascular disease, peripheral artery disease, deep vein thrombosis, antithrombotic, antiplatelets, anticoagulants, low-molecular-weight heparin, DOAC

Thrombosis and Haemostasis
DOI: 10.1055/s-0040-1715798 – ISSN 0340-6245.
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