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Venous Thromboembolism

Further Evidence Supporting the Use of Prophylactic Anticoagulation in Hospitalized Patients With COVID-19

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Network Open

Published Online: June 11, 2021

Invited Commentary

Article Information and Disclosures

Andrew B. Dicks, MD¹;

Ido Weinberg, MD¹

Author Affiliations

¹Fireman Vascular Center, Massachusetts General Hospital, Boston, Massachusetts

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Infection by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), the cause of COVID-19, has been associated with numerous other medical complications aside from the known respiratory effects. Specifically, it is recognized that COVID-19 predisposes patients to thrombotic events in both the arterial and venous circulations. As a result, guidelines from several medical organizations recommend the use of prophylactic anticoagulation in patients with COVID-19.¹ Nonetheless, these guidelines rely on expert opinion–level recommendations, as firm data are lacking. Over time, our knowledge on the use of anticoagulation has been expanding, initially from case series, followed by systemwide reports and international registries. Numerous randomized trials are ongoing. Despite this, a systematic review published in October 2020² found insufficient evidence to determine risks and benefits of use of prophylactic anticoagulation in patients with COVID-19. It is in this landscape that the current study was performed.

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Article Information

Published: June 11, 2021. doi:10.1001/jamanetworkopen.2021.12403

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Dicks AB et al. JAMA Network Open.

Corresponding Author: Ido Weinberg, MD, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (iweinberg@mgh.harvard.edu).

Conflict of Interest Disclosures: Dr Weinberg reported receiving consulting fees from Magneto Thrombectomy Solutions outside the submitted work. No other disclosures were reported.

References

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Flumignan RL , Tinôco JDS , Pascoal PI , et al. Prophylactic anticoagulants for people hospitalised with COVID-19. Cochrane Database Syst Rev. 2020;10(10):CD013739. doi:10.1002/14651858.CD013739 PubMed Google Scholar

Vaughn VM , Yost M , Abshire C , et al. Trends in venous thromboembolism anticoagulation in patients hospitalized with COVID-19. JAMA Netw Open. 2021;4(6):e2111788. doi:10.1001/jamanetworkopen.2021.11788 Google Scholar

Halkin H , Goldberg J , Modan M , Modan B . Reduction of mortality in general medical in-patients by low-dose heparin prophylaxis. Ann Intern Med. 1982;96(5):561-565. doi:10.7326/0003-4819-96-5-561 Google Scholar Crossref

Rentsch CT , Beckman JA , Tomlinson L , et al. Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study. BMJ. 2021;372:n311. doi:10.1136/bmj.n311 Google Scholar Crossref

Nadkarni GN , Lala A , Bagiella E , et al. Anticoagulation, bleeding, mortality, and pathology in hospitalized patients with COVID-19. J Am Coll Cardiol. 2020;76(16):1815-1826. doi:10.1016/j.jacc.2020.08.041 PubMed Google Scholar Crossref

Hunt BJ , De Paula EV , McLintock C , Dumantepe M . Prophylactic anticoagulation for patients in hospital with COVID-19. BMJ. 2021;372:n487. doi:10.1136/bmj.n487 Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.