Team Leads

• Anna Parks, MD (University of California, San Francisco School of Medicine)
• James Anstey, MD (University of California, San Francisco School of Medicine)
• Todd Hecht, MD (University of Pennsylvania School of Medicine)
• David Sterken, MD (University of Wisconsin School of Medicine and Public Health)
• Margaret Fang, MD, MPH (University of California, San Francisco School of Medicine)

Summary of venous and arterial thrombosis risk in COVID-19

Early reports suggested that hospitalized patients with coronavirus disease-19 (COVID-19) were at greatly increased risk of venous and arterial thrombosis (VTE and ATE) despite pharmacologic prophylaxis. As the pandemic wore on, published incidence rates declined from their peak at the beginning of the pandemic toward rates that remain elevated but less markedly so. For example, an early report demonstrated that approximately one-third of critically ill patients from 3 centers in the Netherlands had pulmonary embolism (PE), while a later paper from New York City reported a CVTE rate of 3.3%.^1,2 Additional data also confirmed that the risk of VTE after discharge appears closer to published rates in non-COVID-19 patients.³ Nevertheless, these reports, coupled with laboratory data demonstrating markedly elevated D-dimer, ferritin and other markers of activated hemostasis, prompted consideration of aggressive prophylactic and treatment strategies. In addition, concerns about infection control and limited personal protective equipment led to changes in how VTE is diagnosed, such as using point-of-care testing rather than formal radiographic diagnosis. Hospitals, including HOMERuN consortium members, developed COVID-19 thrombosis guidelines early in the pandemic to aid in clinical decision-making. These guidelines reflected the early uncertainties about VTE risk and optimal management and demonstrated variability across institutions.⁴

More than a year later, the results of clinical trials testing various VTE prevention and management strategies are starting to emerge. In addition, international professional societies have developed evidence-based guidelines. We recommend that HOMERuN collaborative members access trusted external resources summarized in the table below for the most updated guidance on COVID-19 and thrombosis.

Current guideline recommendations for venous thromboembolism prevention with COVID-19

VTE Group Publication

Parks AL, Auerbach AD, Schnipper JS, et al; the Hospital Medicine Reengineering Network (HOMERuN). Venous thromboembolism (VTE) prevention and diagnosis in COVID-19: practice patterns and outcomes at 33 hospitals. PLOS ONE. 2022;17(5):e0266944.

Parks AL, Auerbach AD, Schnipper JL, et al. COVID-19 coagulopathy and thrombosis: analysis of hospital protocols in response to the rapidly evolving pandemic. Thromb Res. 2020;196:355-358.