HAEMATOLOGY
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?
lWould 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? lWill 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
84 l
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OCTOBER 2020
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