HAEMATOLOGY
extended thromboprophylaxis. In the UK, inpatients receive
thromboprophylaxis according to their risk assessment, as standard practice. However, In China, COVID patients were not routinely given heparin until quite late during the pandemic. A study at Tongji Hospital, by Tang et al (2020), showed that anticoagulant treatment was associated with decreased mortality in severe COVID-19 patients with coagulopathy. So, what is the current picture in the UK? At Guys and St Thomas’, 66 critical care patients were followed for a month. All received standard weight adjusted thromboprophylaxis. They discounted all immunothrombosis (segmental or sub- segmental PE). All DVT were line related and, overall, there was a 5% rate of VTE while they were in hospital. She highlighted the need for further research to tackle a number of unanswered questions relating to thrombosis and COVID-19: l What are the current rates of VTE in critically ill patients?
l Are the rates of thrombosis higher than other patients on critical care especially when we compare with non-COVID-19 viral pneumonia?
l In terms of thromboprophylaxis, is weight adjusted thromboprophylaxis better than empirical dosing?
l Would a higher dose of
thromboprophylaxis be beneficial without significantly increasing bleeding risk?
l Should we add in intermittent pneumatic compression? Furthermore, should we give extended thromboprophylaxis?
l Will anticoagulation help immunethrombosis and shouldn’t this be an indication for anti-inflammatory cytokine treatment?
Prof. Hunt commented that what we know is that there is acute lung injury in severe COVID-19 infection with cytokine storm producing a profound inflammatory
state, and ALI/ARDS leads to thrombosis (immunothrombosis) within lung tissue. D-dimers are produced directly from lung inflammation, which is probably why they are a prognostic indicator.
It appears that rates of VTE may be high in COVID-19 but we need to understand whether more anticoagulation will reduce VTE without unacceptable bleeding. “It is illogical to manage thrombosis
secondary to inflammation with anticoagulation; better to manage upstream with antivirals and anti-inflammatory agents,” she concluded.
CSJ
AUGUST 2020
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