Anticoagulation Practice Patterns in COVID‐19: A Global Survey

Rosovsky, Rachel P.; Sanfilippo, Kristen M; Wang, Tzu Fei; Rajan, Sandeep K.; Shah, Surbhi; Martin, Karlyn A.; Ní Áinle, Fionnuala; Huisman, Menno; Hunt, Beverley J; Kahn, Susan R.; Kevane, Barry; Lee, Agnes YY.; McLintock, Claire; Baumann Kreuziger, Lisa

BACKGROUND: Best practice for prevention, diagnosis, and management of venous thromboembolism (VTE) in patients with SARS‐CoV‐2 disease 2019 (COVID‐19) is unknown due to limited published data in this population. OBJECTIVES: We aimed to assess current global practice and experience in management of COVID‐19 associated coagulopathy to identify information to guide prospective and randomized studies. METHODS: Physicians were queried about their current approach to prophylaxis, diagnosis, and treatment of VTE in patients with COVID‐19 using an online survey tool distributed through multiple international organizations between April 10 and 14, 2020. RESULTS: 515 physicians responded from 41 countries. The majority of respondents (78%) recommended prophylactic anticoagulation for all hospitalized patients with COVID‐19 with most recommending use of low‐molecular‐weight heparin or unfractionated heparin. Significant practice variation was found regarding need for dose escalation of anticoagulation outside the setting of confirmed or suspected VTE. Respondents reported the use of bedside testing when unable to perform standard diagnostic imaging for diagnosis of VTE. 291 respondents reported observing thrombotic complications in their patients with 64% noting that the complication was pulmonary embolism (PE). Of the 44% of respondents that estimated incidence of thrombosis in patients with COVID‐19 in their hospital, estimates ranged widely from 1 to 50%. 174 respondents noted bleeding complications (34% minor bleeding, 14% clinically relevant non‐major bleeding, and 12% major bleeding). CONCLUSION: Well‐designed epidemiologic studies are urgently needed to understand the incidence and risk factors of VTE and bleeding complications in COVID‐19 patients. Randomized clinical trials addressing use of anticoagulation are also needed.