Prevention, diagnosis and treatment of venous thromboembolism in patients with COVID-19

CHEST Guideline and Expert Panel Report

Lisa K. Moores, Tobias Tritschler, Shari Brosnahan, Marc Carrier, Jacob F. Collen, Kevin Doerschug, Aaron B. Holley, David Jimenez, Gregoire LeGal, Parth Rali, Philip Wells


Background: Emerging evidence shows that severe coronavirus disease 2019 (COVID-19) can be complicated by a significant coagulopathy, that likely manifests in the form of both microthrombosis and VTE. This recognition has led to the urgent need for practical guidance regarding prevention, diagnosis, and treatment of VTE.

Methods: A group of approved panelists developed key clinical questions by using the PICO (Population, Intervention, Comparator, Outcome) format that addressed urgent clinical questions regarding the prevention, diagnosis, and treatment of VTE in patients with COVID-19. MEDLINE (via PubMed or Ovid), Embase, and Cochrane Controlled Register of Trials were systematically searched for relevant literature, and references were screened for inclusion. Validated evaluation tools were used to grade the level of evidence to support each recommendation. When evidence did not exist, guidance was developed based on consensus using the modified Delphi process.

Results: The systematic review and critical analysis of the literature based on 13 Population, Intervention, Comparator, Outcome questions resulted in 22 statements. Very little evidence exists in the COVID-19 population. The panel thus used expert consensus and existing evidence-based guidelines to craft the guidance statements.

Conclusions: The evidence on the optimal strategies to prevent, diagnose, and treat VTE in patients with COVID-19 is sparse but rapidly evolving.

Key Words: COVID-19, DIC, DVT, hypercoagulability, pulmonary embolism, VTE

Chest. 2020 Jun 2
doi: 10.1016/j.chest.2020.05.559
Copyright © 2020 Published by Elsevier Inc under license from the American College of Chest Physicians.