ACP HospitalistChest Physicians Make 11 Recommendations on Antithrombotic Therapy in COVID-19

An expert panel from the American College of Chest Physicians concluded that the recommendations on the prevention and management of arterial thrombosis and thromboembolism do not significantly differ from those for prepandemic patients.

The American College of Chest Physicians (ACCP) published new recommendations in CHEST on June 29, 2023, for the prevention and management of arterial thrombosis and thromboembolism in patients with COVID-19.

Key Points

• In hospitalized COVID-19 patients who have a baseline indication for antiplatelet therapy due to prior acute coronary syndrome (ACS), continuing antiplatelet therapy is suggested.
• In hospitalized patients with COVID-19 and confirmed ACS, dual antiplatelet therapy (DAPT) is recommended to reduce the risk of recurrent ACS or death.
• In hospitalized patients with COVID-19 and myocardial injury without ACS, the experts suggest against DAPT.
• For hospitalized patients on antiplatelet therapy for a previous stroke, continuing antiplatelet therapy and adding prophylactic-dose low-molecular-weight heparin (LMWH) is suggested.
• In hospitalized patients with COVID-19 who present with acute ischemic stroke and have an indication for recanalization therapy, recanalization therapy is suggested.
• For hospitalized patients with COVID-19 who have an acute stroke or transient ischemic attack of no established etiology, antiplatelet therapy as would be used for non-COVID-19 patients is suggested.

Additional Points

• All recommendations were conditional and ungraded consensus-based statements.
• There was overall a low quality of evidence specific to antithrombosis for COVID-19.
• More high-quality evidence is needed to inform management strategies in these patients.

Conclusion

• The experts noted that the recommendations were not a major departure from arterial thrombosis recommendations from before the pandemic, but that more high-quality evidence is needed to inform management strategies in patients with COVID-19.

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Did You Know?
The risk of arterial thrombosis and thromboembolism in patients with COVID-19 is up to 3 times higher than in the general population.