Anticoagulation Strategies in COVID-19 Management
Summary
The coagulopathy associated with SARS-CoV-2 infection encompasses both macrovascular and microvascular thromboses driven by endothelial injury, inflammation and platelet activation. Early recognition of this prothrombotic state has prompted widespread use of anticoagulant agents, principally heparin derivatives, to mitigate venous thromboembolism (VTE), arterial thrombosis and multiorgan dysfunction. Strategies range from standard prophylactic dosing in medical inpatients to intermediate or full therapeutic regimens in critically ill patients, guided by clinical risk factors, biomarkers such as D-dimer and evolving consensus recommendations. Outpatient management and post-discharge prophylaxis are under investigation to prevent late thrombotic sequelae and long-term vascular complications. Ongoing trials continue to refine the timing, intensity and duration of anticoagulation, balancing thrombosis prevention against bleeding risk and informing global practice guidelines for acute and convalescent phases of COVID-19.
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Anticoagulation Strategies in COVID-19 Management publication trend
The graph below shows the total number of articles in anticoagulation strategies in covid-19 management across all publications each year (not limited to Nature Index journals).
Technical terms
Anticoagulation: Use of pharmacological agents to inhibit clot formation and propagation.
Thromboprophylaxis: Preventive administration of anticoagulants to reduce the likelihood of thrombotic events.
Low molecular weight heparin (LMWH): Semi-synthetic heparin fragments offering more predictable anticoagulant response than unfractionated heparin.
Venous thromboembolism (VTE): Collective term for deep vein thrombosis and pulmonary embolism resulting from intravascular clotting.
Therapeutic anticoagulation: Administration of anticoagulant drugs at doses intended to treat established or high-risk thromboses.
References
- Aspirin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. The Lancet (2021).
- Dosing of thromboprophylaxis and mortality in critically ill COVID-19 patients. Critical Care (2020).
- Venous or arterial thrombosis and deaths among COVID-19 cases: a European network cohort study. The Lancet Infectious Diseases (2022).
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