COVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH.

Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine

Cosmi B.;
2020

Abstract

COVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH.
Gerotziafas G.T.; Catalano M.; Colgan M.-P.; Pecsvarady Z.; Wautrecht J.C.; Fazeli B.; Olinic D.-M.; Farkas K.; Elalamy I.; Falanga A.; Fareed J.; Papageorgiou C.; Arellano R.S.; Agathagelou P.; Antic D.; Auad L.; Banfic L.; Bartolomew J.R.; Benczur B.; Bernardo M.B.; Boccardo F.; Cifkova R.; Cosmi B.; De Marchi S.; Dimakakos E.; Dimopoulos M.A.; Dimitrov G.; Durand-Zaleski I.; Edmonds M.; El Nazar E.A.; Erer D.; Esponda O.L.; Gresele P.; Gschwandtner M.; Gu Y.; Heinzmann M.; Hamburg N.M.; Hamade A.; Jatoi N.-A.; Karahan O.; Karetova D.; Karplus T.; Klein-Weigel P.; Kolossvary E.; Kozak M.; Lefkou E.; Lessiani G.; Liew A.; Marcoccia A.; Marshang P.; Marakomichelakis G.; Matuska J.; Moraglia L.; Pillon S.; Poredos P.; Prior M.; Salvador D.R.K.; Schlager O.; Schernthaner G.; Sieron A.; Spaak J.; Spyropoulos A.; Sprynger M.; Suput D.; Stanek A.; Stvrtinova V.; Szuba A.; Tafur A.; Vandreden P.; Vardas P.E.; Vasic D.; Vikkula M.; Wennberg P.; Zhai Z.; Bikdeli B.; Guo Y.; Harenberg J.; Hu Y.; Lip G.Y.H.; Roldan V.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11585/795817
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