Suggestions for thromboprophylaxis and laboratory monitoring for in-hospital patients with COVID-19

Abstract

Growing evidence from multiple retrospective cohorts indicates that hospitalised COVID-19 patients often could suffer from an excessive coagulation activation leading to an increased risk of venous and arterial thrombosis (including small calibre vessels) and a poor clinical course. Notably, D-dimer level at the time of hospital admission is a predictor of the risk of development of acute respiratory distress syndrome (ARDS), the risk of intensive care admission and the risk of death. An observational study among COVID-19 patients with elevated D-dimer levels at baseline showed that the 28-day mortality was lower in those receiving heparin than in those who did not. Based on the available literature and published recommendations from the International Society of Thrombosis and Hemostasis (https://www.isth.org), from the American Society of Hematology (https://www.hematology.org/covid-19) and from the Society for Thrombosis and Haemostasis Research (http://gth-online.org), the Working Party on Hemostasis (Swiss Society of Hematology) proposes the following recommendations for pharmacological thromboprophylaxis in COVID-19 patients in the acute setting. Suggestions will be regularly updated.