Prevention, diagnosis and treatment of venous thromboembolis
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Given the coagulopathy that often complicates severe COVID-19 illness, certain best practices should be followed for venous thromboembolism (VTE) prevention and treatment, even if data to inform these decisions are scarce, experts said.

Critically or acutely ill COVID-19 patients should receive anticoagulant thromboprophylaxis (unless contraindicated), according to recent guidance from the American College of Chest Physicians. Other interim recommendations from the group include:

-- For thromboprophylaxis, low-molecular-weight heparin (LMWH) -- or the related fondaparinux (Arixtra) -- is favored over unfractionated heparin (UFH), which is in turn recommended over direct oral anticoagulants (DOACs)
-- Discourage use of antiplatelets for VTE prevention in critically or acutely ill patients
-- Discourage routine ultrasound screening for the detection of asymptomatic deep vein thrombosis (DVT) in the critically ill
-- LMWH and UFH are favored over oral anticoagulants for acutely ill patients with proximal DVT or pulmonary embolism
-- Any patient with COVID-19 and proximal DVT or pulmonary embolism should be placed on anticoagulation therapy for at least 3 months.

A big question mark hangs over the dosing of prophylactic anticoagulation for patients with COVID-19: should they receive a standard dose for VTE prophylaxis, an intermediate or escalated dose, or a full-on therapeutic dose?

It's hard to know whether you would pick an intermediate or full dose. The important thing is that patients are protected in some form.", said researchers.

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