The pharmacology of anticoagulant drug treatment options in COVID-19 patients: reviewing real-world evidence in clinical practice

ABSTRACT

Introduction

The optimal anticoagulation strategy for venous thromboembolism (VTE) prevention among COVID-19 patients, hospitalized or in the community setting, is still challenging and largely based on real-world evidence.

Areas covered

We analyzed real-world data regarding the safety and effectiveness of anticoagulant treatment, both parenteral and oral, for VTE prevention or atrial fibrillation (AF)/VTE treatment among COVID-19 patients.

Expert opinion

The efficacy of low-molecular-weight heparin (LMWH) doses for VTE prevention correlates with COVID-19 disease status. LMWH prophylactic dose may be useful in COVID-19 patients at the early stage of the disease. LMWH intermediate or therapeutic dose is recommended in COVID-19 patients with an advanced stage of the disease. COVID-19 patients on VKA therapy for atrial fibrillation (AF) and VTE should switch to NOACs in the community setting or LMWH in the hospital setting. No definitive data on de-novo starting of NOACs or VKA therapy for VTE prevention in COVID-19 outpatients are available. In patients at high risk discharged after hospitalization due to COVID-19, thromboprophylaxis with NOACs may be considered.

KEYWORDS:

• Anticoagulation
• COVID-19
• heparins
• NOACs
• VKAs
• fondaparinux
• safety
• effectiveness
• bleedings

Article highlights

• The effective dose of low-molecular-weight heparin (LMWH) for VTE prevention correlates with COVID-19 disease status.

• LMWH prophylactic dose may be useful in COVID-19 patients at the early stage of the disease.

• LMWH intermediate or therapeutic dose, according to patient’s bleeding risk, is recommended in COVID-19 patients with advanced stages of the disease.

• COVID-19 patients on VKAs therapy for atrial fibrillation (AF) and VTE should switch to NOACs in the community setting or LMWH in the hospital setting.

• No definitive data on de-novo starting of NOACs or VKAs therapy for the VTE prevention in COVID-19 outpatients are available.

• In patients at high risk discharged after hospitalization due to COVID-19, thromboprophylaxis with NOACs may be considered.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.