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.

Gerotziafas, Grigoris T;Catalano, Mariella;Colgan, Mary-Paula;Pecsvarady, Zsolt;Scientific Reviewer Committee;et.al.
(2020) Thrombosis and Haemostasis : international journal for vascular biology and medicine — Vol. 120, n° 12, p. 1597-1628 (2020)

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Authors
  • Gerotziafas, Grigoris Torcid-logo
    Author
  • Catalano, Mariella
    Author
  • Colgan, Mary-Paula
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  • Pecsvarady, Zsolt
    Author
  • Vikkula, Miikkaorcid-logoUCLouvain
    Author
  • Scientific Reviewer Committee
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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.
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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., et al. (2020). 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. Thrombosis and Haemostasis : international journal for vascular biology and medicine, 120(12), 1597-1628. https://doi.org/10.1055/s-0040-1715798 (Original work published 2020)