key: cord-0765233-khdnqufb
authors: Rosovsky, Rachel P.; Sanfilippo, Kristen M; Wang, Tzu Fei; Rajan, Sandeep K.; Shah, Surbhi; Martin, Karlyn A.; Ní Áinle, Fionnuala; Huisman, Menno; Hunt, Beverley J; Kahn, Susan R.; Kevane, Barry; Lee, Agnes YY.; McLintock, Claire; Baumann Kreuziger, Lisa
title: Anticoagulation Practice Patterns in COVID‐19: A Global Survey
date: 2020-07-09
journal: Res Pract Thromb Haemost
DOI: 10.1002/rth2.12414
sha: 39ac681e5869393bd1bafd7443a4acf59652d61a
doc_id: 765233
cord_uid: khdnqufb

BACKGROUND: Best practice for prevention, diagnosis, and management of venous thromboembolism (VTE) in patients with SARS‐CoV‐2 disease 2019 (COVID‐19) is unknown due to limited published data in this population. OBJECTIVES: We aimed to assess current global practice and experience in management of COVID‐19 associated coagulopathy to identify information to guide prospective and randomized studies. METHODS: Physicians were queried about their current approach to prophylaxis, diagnosis, and treatment of VTE in patients with COVID‐19 using an online survey tool distributed through multiple international organizations between April 10 and 14, 2020. RESULTS: 515 physicians responded from 41 countries. The majority of respondents (78%) recommended prophylactic anticoagulation for all hospitalized patients with COVID‐19 with most recommending use of low‐molecular‐weight heparin or unfractionated heparin. Significant practice variation was found regarding need for dose escalation of anticoagulation outside the setting of confirmed or suspected VTE. Respondents reported the use of bedside testing when unable to perform standard diagnostic imaging for diagnosis of VTE. 291 respondents reported observing thrombotic complications in their patients with 64% noting that the complication was pulmonary embolism (PE). Of the 44% of respondents that estimated incidence of thrombosis in patients with COVID‐19 in their hospital, estimates ranged widely from 1 to 50%. 174 respondents noted bleeding complications (34% minor bleeding, 14% clinically relevant non‐major bleeding, and 12% major bleeding). CONCLUSION: Well‐designed epidemiologic studies are urgently needed to understand the incidence and risk factors of VTE and bleeding complications in COVID‐19 patients. Randomized clinical trials addressing use of anticoagulation are also needed.

The novel coronavirus disease 2019 was first identified in Wuhan, China, in December 2019 , and now has infected over 8.6 million people and caused in excess of 460,000 deaths worldwide as of June 20, 2020 (www.statista.com). (1, 2) Studies have demonstrated that patients who died of COVID-19 had higher levels of plasma D-dimers on admission compared with those who survived. (3) (4) (5) (6) (7) Furthermore, autopsy studies of COVID-19 patients have found fibrin thrombi within the pulmonary vasculature supporting the presence of a hypercoagulable state. (8, 9) The overall incidence of venous thromboembolism (VTE) in patients with COVID-19 is unknown. Studies evaluating incidence have been limited to case reports and case series, with estimates ranging from as low as 1% in the general wards to as high as 69% in intensive care units using screening ultrasound. (3) (4) (5) (6) (7) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24) (25) (26) (27) The limited data present a challenge for health care providers in prevention, diagnosis, and management of VTE in patients with COVID-19. We therefore sought to assess current global practice patterns in the management of COVID-19 associated coagulopathy, and to identify unanswered questions that may guide prospective and randomized studies. We asked clinicians to share their experience and recommendations about thromboprophylaxis, diagnosis, and treatment of VTE in patients with COVID-19.

Physicians were surveyed using an online survey tool (SurveyMonkey©). 

This article is protected by copyright. All rights reserved hemorrhagic complications, management of various clinical scenarios in COVID-19 patients, type and intensity of anticoagulation, and laboratory testing and diagnostic approaches. Multiple selections were permitted (such that the combined percentage in each question could exceed 100%)

given the complexity of potential scenarios. Demographics of respondents collected included practice patient population (adult or pediatric), practice location, country of practice, and years of experience.

Survey results were summarized using descriptive statistics. Student's t-tests and chi-square tests were used to evaluate for associations between responses to questions and demographic factors or between survey responses.

Five hundred and fifteen participants answered at least one question on the survey and 71% of participants completed the survey. Baseline characteristics of survey respondents are listed in Table   1 and Figure 1 . Based on the responses of 278 respondents that listed their affiliated hospital, 266 hospitals were represented across 41 countries.

All of the participants provided responses to the question to whom they would recommend thromboprophylaxis. The majority of respondents (78%) recommended prophylactic anticoagulation for all hospitalized patients with COVID-19, while 43% also selected that they would follow institutional guidelines for criteria for prophylaxis. Eight percent of respondents recommended thromboprophylaxis for all patients with COVID-19, irrespective whether inpatient or outpatient.

Multiple selections for choice of anticoagulant were allowed. Of the 453 respondents who indicated use of LMWH for thromboprophylaxis, 61% (n=278) recommended fixed dose LMWH and 62% (n=281) recommended weight-adjusted LMWH. One-third recommended unfractionated heparin (UFH) (22% prophylactic fixed dose and 12% weight-adjusted dose). Direct oral anticoagulants (DOAC) were recommended by 6% (n=27) with another 6% recommended a variety of other regimens including escalated doses of LMWH for all patients or based on D-dimer or disease severity.

In response to when dose escalation of prophylactic anticoagulation to intermediate dose was considered, 28% (n=122) of respondents did not recommend escalated doses of prophylactic anticoagulation for any indication ( Figure 2 ). If recommended, a variety of factors were used to select patients for dose escalation, ( Figure 2 ) and LMWH was the most commonly mentioned agent (98%; n=279) followed by UFH (26%; n=73). Recommendations to escalate to intermediate dosing did not differ between physicians practicing in the US and other countries, between providers practicing in hospitals with <250 COVID+ patients or >250 COVID+ patients, or between hematologists and other medical specialties. Eighty-two percent of physicians recommending dose escalation also noted their patients experienced thromboembolism compared to 69% of physicians who did not recommend intermediate prophylaxis (p<0.01).

Recommendations for escalation to a therapeutic dose of anticoagulation was reported by 398 (77%) of respondents. Indications for dose escalation included a new diagnosis of atrial fibrillation (AF) or VTE (86%, n=341) and high clinical suspicion of VTE but unable to obtain diagnostic testing (78%, n=310). No respondents reported that they would escalate to therapeutic anticoagulation in all patients hospitalized with COVID-19, while 2% reported that there was no indication that would lead them to escalate to therapeutic anticoagulation ( Figure 2 ). Other indications for which respondents would escalate to therapeutic doses of anticoagulant therapy varied including some respondents using certain clinical scoring systems to guide escalation to full dose anticoagulation ( Figure 2 ). In addition, seven respondents reported clotting of circuits such as continuous renal replacement therapies (CRRT), dialysis filters, or extracorporeal membrane oxygenation (ECMO) catheters leading them to recommend escalation to therapeutic anticoagulation for those affected patients.

Ninety-six percent of the 391 respondents recommended LMWH, 48% UFH, 27% DOAC, 13% vitamin K antagonist (VKA), 10% fondaparinux, and 7% intravenous (IV) direct thrombin inhibitors for therapeutic anticoagulation.

Extended VTE prophylaxis (post-discharge), depending on the presence of risk factors, was recommended by 276 of the 449 (62%) respondents who answered this question. The most common risk factor for recommending this approach was a history of VTE prior to COVID-19 (31%, n=141), but other indications included a history of cancer (24%, n=109), patients who required admission to ICU (22%, n=98), and patients meeting inclusion criteria of prior trials for extended prophylaxis for medically ill patients (21%, n=93). Other risk factors identified include hospitalization for COVID-19 (20%, n=87), D-dimer greater than two-times ULN (18%, n=79), obesity (15%, n=69), and pregnancy

This article is protected by copyright. All rights reserved (12%, n=54). Most respondents recommend LMWH (78%, n=207) for extended VTE prophylaxis, followed by rivaroxaban (32%, n=86), apixaban (24%, n=65), and betrixaban (2%, n=6).

Recommendations for extended prophylaxis did not differ between physicians practicing in the US and other countries, but was more often recommended by those who practiced in hospitals with more than 250 COVID-19 admissions (67% vs 54%, p=0.02), hematologists/oncologists compared to other medical specialties (67% vs. 47%, p<0.01), or from physicians who noted their patients experienced thrombotic complications (66% vs 38%, p<0.01).

Three hundred and ninety-one (75%) participants responded to questions regarding using participants reported testing based on the D-dimer results, and 8% reported testing in all ICU patients (some even reported monitoring periodically or based on D-dimer trends). An additional 2% reported obtaining CUS in all patients upon hospital admission. If unable to obtain standard imaging, 59% reported diagnosing patients with PE based on worsening respiratory status or right heart strain on bedside echocardiogram. Fifty-five percent reported using hemodynamic instability, 48% reported unilateral limb swelling and 42% reported using clinical scoring tools. An additional 35% reported using increasing D-dimer, 11% reported IV-line malfunction or increase in ventilated to perfused lung areas (i.e. dead space), and 5% reported the need for proning as surrogates for thrombosis.

Three hundred and ninety-two (76%) respondents answered questions regarding baseline laboratory ordering practices while 380 answered questions regarding ongoing laboratory monitoring. The most frequent baseline laboratory test ordered was a complete blood cell count (CBC; 93.9%). Laboratory tests ordered at baseline by more than 75% of respondents included D-dimer, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and C-reactive protein (CRP). Additional laboratory tests frequently ordered included baseline basic metabolic panel (BMP) or comprehensive metabolic panel (CMP), ferritin, and lactate dehydrogenase. Similarly, the most frequent laboratory tests ordered to monitor COVID-19 patients at least three times per week was a CBC. Additional laboratory tests ordered at least three times per week by more than 50% of respondents included:

BMP, D-dimer, PT, aPTT, fibrinogen, and CRP. The infrequently ordered (< 5%) coagulation tests at

This article is protected by copyright. All rights reserved baseline or for routine monitoring included antithrombin activity, ADAMTS-13 activity, antiphospholipid antibodies (APLAs), thromboelastography (TEG), troponin, and von Willebrand factor activity. Lastly, when asked about changes in practice, several respondents indicated a shift from monitoring UFH using aPTT to monitoring with anti-Xa levels, while some respondents indicated incorporating the practice of using anti-Xa levels to monitor dosing of prophylactic or therapeutic LMWH.

Questions about bleeding complications were answered by 377 (73%) physicians. Over half (n=203) reported they had witnessed no bleeding complications, minor bleeding was reported by 34% (n=129), clinically relevant non-major bleeding by 14% (n=54) and major bleeding by 12% (n=46).

The most common bleeding sites reported included cutaneous/line related (41%, n=65), mucous membranes (41%, n=65), gastrointestinal (27%, n=43), hemoptysis/alveolar hemorrhage (22%, n=35), genitourinary (16%, n=27), retroperitoneal (13%, n=21), neurologic (10%, n=16), and muscular (3%, n=2). Bleeding complications were most often reported in patients on therapeutic anticoagulation (65%, n=97), followed by intermediate (27%, n=41) or prophylactic dose (41%, n=62). Nine percent of respondents reported that bleeding occurred without anticoagulation.

When queried about the approximate incidence of VTE in COVID-19 patients, 56% of the 293 and 55% of the 290 participants did not know the incidence in their hospitalized and ICU patients, respectively ( Figure 3 ). Of the respondents who estimated the incidence of thrombosis, approximates ranged from 1% to >50% ( Figure 3 ). Incidence of thrombosis was estimated to be higher in ICU 

This article is protected by copyright. All rights reserved Of the 367 respondents who reported on thrombotic complications, 21% (n=76) reported no thrombotic complications in their COVID-19 patients. The majority of thrombotic complications reported were PE (64%, n=234) followed by lower extremity DVT (49%, n=181), upper extremity DVT (19%, n=71), and superficial vein thrombosis (9%, n=34). Few participants identified thrombosis in unusual locations with 5% (n=19) reporting intracardiac thrombosis, 3% (n=11) splenic vein thrombosis and 4% (n=13) cerebral vein thrombosis. For arterial thrombosis, 20% (n=75) of respondents reported ischemic stroke, 12% (n=52) myocardial infarction, and 9% (n=34) peripheral artery embolism had occurred in their patients. Twenty nine percent (n=105) of respondents reported a high clinical suspicion for VTE in patients for whom they were unable to obtain diagnostic testing.

In addition, 16% (n=59) reported sudden death with concern for thrombosis. For adjunctive therapies, 12% (n=45) reported thrombotic complications associated with mechanical circulatory support (i.e. ECMO, ventricular assist device), and 25% (n=90) reported these complications with dialysis or CRRT.

The COVID-19 pandemic has affected all countries and has required rapid adaptation to clinical practice with limited published evidence. Our survey identified several areas with consensus on management of COVID-19, including the use of therapeutic anticoagulation for all confirmed or clinically suspected VTE and universal use of thromboprophylaxis for all hospitalized patients. Our study also demonstrated significant differences in practice patterns such as the decision to escalate the dose of anticoagulation and/or to consider extended prophylaxis and in the use of laboratory monitoring. The indication to consider dose escalation from prophylactic to intermediate doses of anticoagulation is a subject of debate that is not currently informed by high quality data.

International guidance reflects this discrepancy in practice, with some organizations suggesting intermediate dose anticoagulation for prophylaxis whereas others have not (Table 2 ). Escalation to intermediate dosing for thromboprophylaxis in ICU patients, may be based on the limited existing data that suggests ICU patients have a higher risk of VTE than non-critical care patients (Table 3) .

Almost one third of our respondents recommended dose escalation in obese patients, likely based on prior studies: one retrospective analysis demonstrated decreased VTE incidence in obese patients with escalated prophylactic dosing, (42) and another showed that weight based dosing of enoxaparin, 0.5 mg/kg twice daily, achieved higher anti-Xa levels in obese patients compared to prophylactic or fixed dosing.(43) However, major VTE guidelines have not addressed weight-based dosing due to lack of randomized data, and additional studies are needed.

We also found that while the majority of respondents recommended escalation to therapeutic anticoagulation only in those with confirmed or high suspicion of VTE, a small number of clinicians recommended escalation to therapeutic anticoagulation in patients with additional risk factors (such as elevated D-dimer). The risks and benefits of this approach remain unknown and several multicenter international trials are underway to address the utility of escalating doses of anticoagulation in hospitalized COVID-19 patients.

There is also uncertainty in the role for extended prophylaxis. While the majority of respondents (62%) recommended this practice for selected patients with COVID-19, there were a variety of clinical factors influencing this practice. Furthermore, while LMWH was the most commonly recommended agent for extended prophylaxis, additional anticoagulants, including various DOACs, were suggested. These responses highlight the variability of current clinical practice and the uncertainty surrounding optimal management. The role for extended prophylaxis following hospitalization has been previously studied because of a high percentage of VTE events (as high as 57%) occurring after hospital discharge.(44) Two DOACs, rivaroxaban and betrixaban, have been approved for extended prophylaxis (30-45 days); (45, 46) however, they are not approved or Accepted Article reimbursed for this indication in all countries, and how often these regimens are used in practice remains unclear. Moreover, our study demonstrates that the acutely ill population in these studies are not the only factors influencing the decision to recommend extended prophylaxis. Extended VTE prophylaxis has been shown to be beneficial in clinical settings such as following orthopedic surgery, and abdominal and pelvic surgery for cancer patients, (47) as well as in high-risk ambulatory patients with cancer receiving chemotherapy. (48, 49) Our study supports that clinicians are concerned that patients with COVID-19 are at increased risks of VTE leading to recommendations for a role for extended thromboprophylaxis following discharge; a practice that is considered in many guidelines. The number of studies reporting VTE continues to increase although rates of VTE vary dramatically ( In the Boston area study, the overall rate of hemorrhage was 4.8% which was similar to the overall rate of VTE reported. (7) In a recent study from the United Kingdom of patients admitted to a critical care unit, 11% suffered from a major bleed. (17) Similarly, in a French study of 92 ICU patients, the overall rate of hemorrhagic events was 21%, and notably, 84% of those were on therapeutic anticoagulation.(18) In the current survey, 43% of respondents noted that their patients had bleeding complications. Importantly, this response does not reflect a true bleeding incidence; it is the percentage of bleeding per respondent and not per patient. Furthermore, it may be influenced by recall bias in our survey, lack of documentation of bleeding complications in previous studies, and difficulty with obtaining data on hemorrhage without intensive chart review. The majority of bleeding Accepted Article events (65%) were reported to be on therapeutic anticoagulation, which is similar to what has been described in the latest studies. In a recent nationwide dataset from China, patients found to have a high risk of VTE using the Padua Prediction Score on admission were also found to have a high risk of bleeding.(57) Thus, attention should be paid to the balance of bleeding and thrombosis in the management of patients with COVID-19 and more studies evaluating these risks are much needed.

Laboratory monitoring of hospitalized patients with COVID-19 provides a means to guide care, but also may provide predictive and prognostic information. One of the most commonly reported abnormal laboratory findings in patients with COVID-19 is highly elevated D-dimer levels. Although rare, COVID-19 can be associated with DIC, usually in the later stages of infection. (70) While the current guidelines provide recommendations for the management of COVID-19-associated DIC, these recommendations are conflicting. (28, 29, 64, 71) The interim ISTH guidance supports keeping the platelet count > 25 x 10 9 /L in patients with DIC even in the absence of bleeding (Table   4 ). (29, 64) However, the recently published guidance from ACC and the ASH guidance statement recommend use of blood products only in the setting of DIC-related bleeding and/or for those in need of invasive procedures or with high risks of bleeding (Table 4) Routine testing for APLAs is not recommended in patients with COVID-19 [6] and only 5% of survey participants reported checking APLAs at baseline. Disease severity and medications used in COVID-Accepted Article 19 can affect lupus anticoagulant (LAC) testing. Additional coagulation laboratory testing is either not recommended for routine patient management (e.g. thromboelastography) (71) or is indicated only in special circumstances.(61) In line with this counsel, less than 5% of respondents pursue these tests.

Our study provides valuable information to reflect the current practice pattern of a diverse background of clinicians from 41 countries. However, we note a few limitations. Due to the nature of the survey, recall biases of the perceived rates of bleeding or thrombotic complications are likely.

Although physicians from 41 countries responded to the survey, there is limited representation from the Asian or African countries. Furthermore, we are unable to provide the percentage of respondents as we could not collect information on the total number of persons who were invited to participate.

Our survey was sent via email to multiple international thrombosis groups as well as available on 

This article is protected by copyright. All rights reserved 

This article is protected by copyright. Tables: Table 1 : Demographics and Characteristics of Survey Respondents Legend: This figure represents the estimated incidence of thrombosis, reported by each respondent, for all hospitalized patients and ICU patients.

This article is protected by copyright. All rights reserved 

This article is protected by copyright. All rights reserved 

This article is protected by copyright. All rights reserved 

This article is protected by copyright. All rights reserved

A VTE prophylaxis recommendations should be modified based on extremes of body weight, severe thrombocytopenia (i.e. platelet counts of 50,000 x 10 9 per liter or 25,000 x 10 9 per liter). DOACs should be considered with caution as co-administration of immunosuppressant, antiviral and other experimental therapies may potentiate or interfere with DOAC therapy B Favors this approach to limit staff exposure. C Cautions against the use of DOACs in these patients secondary to the high risk of rapid clinical deterioration in these patients.

This article is protected by copyright. All rights reserved 

An interactive web-based dashboard to track COVID-19 in real time

Clinical features of patients infected with 2019 novel coronavirus in Wuhan

Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia

Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

COVID and Coagulation: Bleeding and Thrombotic Manifestations of SARS-CoV2 Infection

Vander Heide RS. Pulmonary and Cardiac Pathology in Covid-19: The First Autopsy Series from New Orleans

Clinical pathology of critical patient with novel coronavirus pneumonia ( COVID-19). Preprints (not peer reviewed)

Accepted Article This article is protected by copyright. All rights reserved 10

Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia

Clinical Characteristics of Covid-19 in New York City

Incidence of thrombotic complications in critically ill ICU patients with COVID-19

Pulmonary Embolism in COVID-19 Patients: Awareness of an Increased Prevalence

Systematic assessment of venous thromboembolism in COVID-19 patients receiving thromboprophylaxis: incidence and role of D-dimer as predictive factors

Pulmonary embolism in patients with Covid-19 pneumonia

Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels

Image-proven thromboembolism in patients with severe COVID-19 in a tertiary critical care unit in the United Kingdom

Accepted Article This article is protected by copyright. All rights reserved 18

Thrombotic and hemorrhagic events in critically ill COVID-19 patients: a French monocenter retrospective study

High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study

High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients

Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in

Incidence of venous thromboembolism in hospitalized patients with COVID-19

Venous Thrombosis Among Critically Ill Patients With Coronavirus Disease 2019 (COVID-19)

Thrombotic complications of patients admitted to intensive care with COVID-19 at a teaching hospital in the United Kingdom

High prevalence of deep vein thrombosis in mechanically ventilated COVID-19 patients

Deep Vein Accepted Article This article is protected by copyright. All rights reserved Thrombosis in Hospitalized Patients with Coronavirus Disease

Venous Thromboembolism in Critically Ill Patients with Covid-19: Results of a Screening Study for Deep Vein Thrombosis

COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up

ISTH interim guidance on recognition and management of coagulopathy in COVID-19

Prevention Treatment of VTEAwC-ICSG. Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines

BTS Guidance on Venous Thromboembolic Disease in patients with COVID-19

Practical guidance for the prevention of thrombosis and management of coagulopathy and disseminated intravascular coagulation of patients infected with COVID-19: British Society of Hematology

COVID-19 and VTE/Anticoagulation: Frequently Asked Questions

Accepted Article This article is protected by copyright. All rights reserved 34

Prevention, diagnosis and treatment of venous thromboembolism in patients with COVID-19: CHEST Guideline and Expert Panel Report

Subcommittee on Perioperative CCTHotSSCotISoTH. Scientific and Standardization Committee Communication: Clinical Guidance on the Diagnosis, Prevention and Treatment of Venous Thromboembolism in Hospitalized Patients with COVID-19

Thromboembolism and Anticoagulant Therapy During the COVID-19 Pandemic: Interim Clinical Guidance from the Anticoagulation Forum

COVID-19 associated coagulopathy and thromboembolic disease: Commentary on an interim expert guidance

Emergence of Institutional Antithrombotic Protocols for Coronavirus

Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)

More than an anticoagulant: Do heparins have direct anti-inflammatory effects?

Using heparin molecules to manage COVID

Prospective comparison of three enoxaparin dosing regimens to achieve target anti-factor Xa levels in hospitalized, medically ill patients with extreme obesity

Duration of venous thromboembolism risk across a continuum in medically ill hospitalized patients

Extended Thromboprophylaxis with Betrixaban in Acutely Ill Medical Patients

Rivaroxaban for Thromboprophylaxis after Hospitalization for Medical Illness

NCCN Guidelines Insights: Cancer-Associated Venous Thromboembolic Disease, Version 2

Apixaban to Prevent Venous Thromboembolism in Patients with Cancer

Rivaroxaban for Thromboprophylaxis in High-Risk Ambulatory Patients with Cancer

Diagnosis, Prevention, and Treatment of Thromboembolic Complications in COVID-19: Report of the National Institute for Public Health of the Netherlands

Accepted Article This article is protected by copyright. All rights reserved 51

COVID-19 pneumonia with hemoptysis: Acute segmental pulmonary emboli associated with novel coronavirus infection

Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis

Anticoagulation, Immortality, and Observations of COVID-19. Research and Practice in Thrombosis and Haemostasis

Thrombosis and Thromboembolism Related to COVID-19 A clarion call for obtaining solid estimates from large-scale multicenter data

Attention should be paid to venous thromboembolism prophylaxis in the management of COVID-19

Laboratory abnormalities in patients with COVID-2019 infection

Hypercoagulability of COVID-19 patients in Intensive Care Unit. A Report of Thromboelastography Findings and other Parameters of Hemostasis

COVID-19-Related Severe Hypercoagulability in Patients Admitted to Intensive Care Unit for Acute Respiratory Failure

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

COVID-19 and aPL Antibodies: Frequently Asked Questions 2020

COVID-19 and D-dimer: Frequently Asked Questions 2020

Laboratory haemostasis monitoring in COVID-19

Practicalguidance for theprevention of thrombosis and management of coagulopathy and disseminated intravascular coagulationof patients infected with COVID-19 2020

A Proposal for Staging COVID-19 Coagulopathy. Research and Practice in Thrombosis and Haemostasis

Clinical Characteristics of Coronavirus Disease 2019 in China

Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease

D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19

Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia

COVID-19 and Coagulopathy: Frequently Asked Questions

This article is protected by copyright. All rights reserved

Non-