Venous Thromboembolism Prevention in COVID-19: A Review of Latest Evidences

Muchammad Dzikrul Haq Karimullah, Nisa Amnifolia Niazta, Hiradipta Ardining


COVID-19 has become major public health problems, with new cases and deaths growing around the world. COVID-19 has been reportedly associated with hypercoagulable state which can lead to venous thromboembolism (VTE) formation. This condition is also associated with worse outcomes in COVID-19 patients, therefore, it is critical for clinicians to identify this condition and manage it accordingly. VTE formation in COVID-19 occurs through several mechanisms, such as inflammatory reaction leading to hypercoagulable state and vascular dysfunction, direct vascular injury by the virus, and immobilization of the patients. The rate of VTE formation is as high as 31% in ICU patients and 9.2% in general wards patients, and it is also associated with poorer prognosis. Thromboprophylaxis with heparin, particularly low molecular weight heparin (LMWH), has been shown to improve the prognosis in these patients. A careful individual assessment is required to determine which patients will benefit from this therapy, as there are still no sufficient prospective trials to establish guidelines for VTE thromboprophylaxis in COVID-19. The assessment includes laboratory parameters such as PT, platelet count, D-dimer, fibrinogen, and other risk factors incorporated in PADUA risk assessment model (RAM), versus the risk of bleeding incorporated in IMPROVE bleeding RAM.


venous thromboembolism; hypercoagulability; coronavirus; COVID-19; low molecular weight heparin

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Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol. 2020;215(108427).

Harapan H, Itoh N, Yufika A, Winardi W, Keam S, Te H et al. Coronavirus disease 2019 (COVID-19): A literature review. J Infect Public Health. 2020;3(5):667–73.

Euronews. Coronavirus Breakdown of Deaths and Infections Worldwide [Internet]. 2020. Available from: DATA COVID-19 DI INDONESIA. 2020.

Zhai Z, Li C, Chen Y, Gerotziafas G, Zhang Z, Wan J, et al. Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines. Thromb Haemost. 2020;120(6):937–48.

Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020

Hoffbrand AV, Moss PA. Hoffbrand’s Essential Haematology. 7th ed. West Sussex, UK: John Wiley & Sons; 2016.

Huerta A, Montani D, Savale L, Pichon J, Tu L, Parent F. Endothelial cell dysfunction: a major player in SARS-CoV-2 infection (COVID-19)? Eur Respir J. 2020;55(6).

Giannis D, Ziogas I, Gianni P. Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J Clin Virol. 2020;127(104362).

Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18(5).

Aryal M, Gosain R, Donato A, Panthak R, Bhatt V, Katel A. Venous Thromboembolism in COVID-19: Towards an Ideal Approach to Thromboprophylaxis, Screening and Treatment. Curr Cardiol Rep. 2020;22(52).

Klok F, Kruip M, Meer N, Arbous M, Gommers D, Kant K. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145–7.

Gillet F, Behr J, Calame P, Aubry S, Delabrousse E. Acute Pulmonary Embolism Associated with COVID-19 Pneumonia Detected by Pulmonary CT Angiography. Radiology. 2020

Negri E, Piloto B, Morigana L, Jardim C, Lamy S, Ferreira M. Heparin therapy improving hypoxia in COVID-19 patients - a case series. Medrxiv. 2020

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844–7.

Connor JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020;135(23):2033–40.

Middledorp S, Coppens M, Haaps T, Foppen M, Vlaar, APMuller M. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. 2020.

Iba T, Di Nisio M, Levy JH, Kitamura N, Thachil J. New criteria for sepsis-induced coagulopathy (SIC) following the revised sepsis definition: A retrospective analysis of a nationwide survey. BMJ Open. 2017;7(9):1–7.

Xu J, Wang L, Zhao L, Li F, Liu J, Zhang L. Risk assessment of venous thromboembolism and bleeding in COVID-19 patients. Res Sq. 2020.

Philip Trapskin, PharmD B. Venous Thromboembolism Prophylaxis – Adult – Inpatient / Ambulatory – Clinical Practice Guideline. Uwhc. 2016;1–19.

Schünemann HJ, Cushman M, Burnett AE, Kahn SR, Beyer-Westendorf J, Spencer FA, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: Prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv. 2018;2(22):3198–225.

Tal S, Spectre G, Kornowski R, Perl L. Venous Thromboembolism Complicated with COVID-19: What Do We Know So Far? Acta Haematol. 2020

Thachil J, Tang N, Gando S, Falanga A, Cattaneo M, Levi M. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18(5)


Moores L, Tritschler T, Brosnahan S, Carrier M, Collen J, Doerschug K. Prevention, diagnosis and treatment of venous thromboembolism in patients with COVID-19: CHEST guideline and expert panel report. Chest. 2020.

Jose R, Manuel A. COVID-19 cytokine storm: the interplay between inflammation and coagulation. Lancet Respir Med. 2020;8(6):e46–7.

Shi C, Wang C, Wang H, Yang C, Cai FEI, Zeng F, et al. The potential of low molecular weight heparin to mitigate cytokine storm in severe covid-19 patients: a retrospective clinical study. medRxiv. 2020;2020.03.28.20046144.

Zipes D, Libby P. Braunwald’s Heart DIsease : A Textbook of Cardiovascular Medicine. In: Bonow R, Mann D, Tomaselli G, editors. Braunwald’s Heart Disease. 11th ed. Elsevier; 2018. p. 1822–45.

Ranucci M, Ballota A, Dedda U, Bayshnikova E, Poli MD, Resta M, et al. The Procoagulant Pattern of Patients with COVID-19 with Acute Respiratory Distress Syndrome. J Thromb Haemost. 2020.

Neumann I, Izcovich A, Zhang Y, Rada G, Kahn SR, Spencer F, et al. DOACs vs LMWHs in hospitalized medical patients: a systematic review and meta-analysis that informed 2018 ASH guidelines. Blood Adv. 2020;4(7):1512–7.



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