ISTH interim guidance on recognition and management of coagulopathy in COVID-19: A Comment.

Barrett, Christopher D; Moore, Hunter B; Yaffe, Michael B; Moore, Ernest E

We read with interest the International Society on Thrombosis and Hemostasis interim guidance on recognition and management of coagulopathy in COVID-19 (1). We applaud this group's efforts in releasing a timely article on the pandemic impacting all regions of the globe. While we agree that this interim guidance addresses important considerations for monitoring the disease process, we believe that the proposed treatment strategy of prophylactic low molecular weight heparin (LMWH) to treat severe COVID-19 coagulopathy is an unconvincing strategy. Patients that are critically ill with COVID-19 have hallmark signs of disseminated intravascular coagulation (DIC)(2), and as noted in the ISTH interim guidance and our own clinical practice, thrombosis is the overwhelming phenotype with rare bleeding complications. We address this concern with the existing data on the severe hypercoagulable state of COVID-19 victims and advocate for consideration of systemic anticoagulation with unfractionated heparin to prevent life threatening micro- and macrovascular thrombosis to mitigate their associated consequences, up to and including progression of respiratory and organ failure.