key: cord-0754878-t9jmilo0
authors: Wang, Ping; Wang, Rong; Tang, Juanjuan; Li, Yang; Ma, Jinjun
title: Assessment of administering antithrombosis in COVID-19 patients with acute hypoxemic respiratory failure
date: 2021-02-22
journal: Int J Cardiol
DOI: 10.1016/j.ijcard.2021.02.049
sha: 255ec8e8678adccfcf2ddd949d81d97710a056ee
doc_id: 754878
cord_uid: t9jmilo0

nan

We read the article by Marco Schiavone et al. [1] with great interest, recently published in this journal. This study found that the mortality rate of COVID-19 patients with acute hypoxemic respiratory failure (ARHF) was significantly reduced with in-hospital heparin administration while oral anticoagulation (OAC) appeared to be ineffective effect. We think that there are some additional points about anticoagulant therapy especially with ARHF that needed to be mentioned.

Firstly, COVID-19 patients showed approximately 20% of severe coagulation abnormalities and almost all the severe and critically ill patients had major coagulation disorders [2] . Secondly, all severe and critically ill patients have a high risk of venous thromboembolism (VTE), so prevention of VTE is strongly recommended in absence of contraindication and low molecular weight heparin(LMWH) is recommended as first-line treatment [3] . Thirdly, some clinical studies demonstrated that evaluation of coagulation parameters such as D-dimer, FDP, and fibrinogen may have prognostic values and be important therapeutic marker. Heparin treatment appears to be associated with better prognosis in severe COVID-19 patients with coagulopathy [4] . Additionally, OAC patients who switched to heparin during hospitalization showed reduced mortality rate in COVID-19 patients with ARHF [1] . Barnes et al. suggested that VTE prophylaxis for all in-hospital COVID-19 patients and switching OACs to shorter acting drugs such as LWMH [5] .

In conclusion, clinicians should choose an optimal strategy of thrombo -prophylaxis and treatment according to repeated assessment of thromboembolism and bleeding risk combined with patients' clinical conditions, particularly in severe and critically ill patients.

The authors report no relationships that could be construed as s conflict of interest.

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Prevention and treatment of venous thromboembolism associated with coronavirus disease 2019 infection: A consensus statement before guidelines

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Thromboembolism and anticoagulant therapy during the covid-19 pandemic: Interim clinical guidance from the anticoagulation forum