Venous thromboembolism in COVID 19 infection: Prevalence and practice of prophylaxis - A narrative

• Main Authors: U Vasudeva Rao, M D Wasim
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2021-01-01
• Series: Indian Journal of Vascular and Endovascular Surgery
• Subjects: anticoagulant; covid 19; heparin; venous thromboembolism prophylaxis; venous thromboembolism
• Online Access: http://www.indjvascsurg.org/article.asp?issn=0972-0820;year=2021;volume=8;issue=3;spage=199;epage=204;aulast=Rao

The aims of this review are to ascertain the true prevalence of venous thromboembolism (VTE) in critically ill COVID 19 patients, to explore the strategy regarding prophylaxis and whether intensified prophylaxis is required for critically ill patients and to review the published guidelines to identify areas where clarity is required. An electronic search of the literature on VTE in COVID patients with reference to prevalence and prophylaxis was made using PubMed as the main search engine. A snowball search was followed to retrieve additional relevant data. The database consisted of prospective and retrospective studies and systematic reviews. The results showed that the reported incidence of VTE varies from <10% to more than 60%. Majority of studies reported a higher incidence of VTE in critically ill COVID 19 patients. Few authors, therefore, suggested a higher dose of low molecular weight heparin (LMWH), but this approach has not been validated. There is also a suggestion to extend the prophylaxis postdischarge. There are also reports of thromboprophylaxis with LMWH improves outcome in critically ill patients. This review confirms the generally held view that the incidence of VTE is higher in COVID 19 patients who are critically ill. However, whether they will benefit from a higher or intensified dose of Heparin is not fully assessed, with opinion equally divided among researchers there are few other grey areas like prophylaxis post discharge and in ambulatory patients.