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Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID‐19

  • Dobesh, Paul P.1
  • Trujillo, Toby C.2
  • 1 University of Nebraska Medical Center 986145 Nebraska Medical Center Omaha, USA , (United States)
  • 2 University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences C238‐V20 Pharmacy & Pharmaceutical Sciences, USA , (United States)
Published Article
John Wiley and Sons Inc.
Publication Date
Oct 01, 2020
DOI: 10.1002/phar.2465
PMID: 33006163
PMCID: PMC7537066
PubMed Central
External links


Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)has led to a world‐wide pandemic, and patients with the infection are referred to as having COVID‐19. Although COVID‐19 is commonly considered a respiratory disease, there is clearly a thrombotic potential that was not expected. The pathophysiology of the disease and subsequent coagulopathy produce an inflammatory, hypercoagulable, and hypofibrinolytic state. Several observational studies have demonstrated surprisingly high rates of venous thromboembolism (VTE) in both general ward and intensive care patients with COVID‐19. Many of these observational studies demonstrate high rates of VTE despite patients being on standard, or even higher intensity, pharmacologic VTE prophylaxis. Fibrinolytic therapy has also been used in patients with acute respiratory distress syndrome. Unfortunately, high quality randomized controlled trials are lacking. A literature search was performed to provide the most up‐to‐date information on the pathophysiology, coagulopathy, risk of VTE, and prevention and treatment of VTE in patients with COVID‐19. These topics are reviewed in detail, along with practical issues of anticoagulant selection and duration. Although a number of international organizations have produced guideline or consensus statements, they do not all cover the same issues regarding anticoagulant therapy for patients with COVID‐19, and they do not all agree. These statements and the most recent literature are combined into a list of clinical considerations that clinicians can use for the prevention and treatment of VTE in patients with COVID‐19.

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