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COVID-19 coagulopathy is multifactorial, and manifests as increased rates of thrombotic complications for patients hospitalized with COVID-19, driven by particularly high rates of thrombotic complications in the ICU, as well as an increased risk of bleeding.


presents approximately 2 weeks after vaccination and is due to autoantibodies directed against the platelet factor 4 antigen. While data are limited, one study reported data which did not demonstrate increase in deep venous thrombosis development following COVID-19 vaccination.20


Conclusion In conclusion, COVID-19 coagulopathy is multifactorial, and manifests as increased rates of thrombotic complications for patients hospitalized with COVID-19, driven by particularly high rates of thrombotic complications in the ICU, as well as an increased risk of bleeding. Management currently involves antithrombotic therapy for those hospitalized for COVID-19, with selected interventions performed for patient support or in line with prior guidelines for a specific pathology. Studies are ongoing to optimize treatment and improve outcomes for patients with COVID-19.


References


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2. Al-Samkari H, Karp Leaf RS, Dzik WH, et al. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood. Jul 23 2020;136(4):489-500. doi:10.1182/blood.2020006520


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28 IRQ | SPRING 2022


8. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. Mar 17 2020;323(11):1061-1069. doi:10.1001/jama.2020.1585


9. Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost. Apr 17 2020;doi:10.1111/jth.14849


10. Investigators R-C, Investigators AC-a, Investigators A, et al. Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19. N Engl J Med. Aug 26 2021;385(9):777-789. doi:10.1056/ NEJMoa2103417


11. Investigators A, Investigators AC-a, Investigators R-C, et al. Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19. N Engl J Med. Aug 26 2021;385(9):790-802. doi:10.1056/NEJMoa2105911


12. Connors JM, Brooks MM, Sciurba FC, et al. Effect of Antithrombotic Therapy on Clinical Outcomes in Outpatients With Clinically Stable Symptomatic COVID-19: The ACTIV-4B Randomized Clinical Trial. JAMA. Nov 2 2021;326(17):1703-1712. doi:10.1001/ jama.2021.17272


13. Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up. J Am Coll Cardiol. Apr 15 2020;doi:10.1016/j. jacc.2020.04.031


14. Cuker A, Tseng EK, Nieuwlaat R, et al. American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: May 2021 update on the use of intermediate-intensity anticoagulation in critically ill patients. Blood Adv. Oct 26 2021;5(20):3951-3959. doi:10.1182/ bloodadvances.2021005493


15. Moores LK, Tritschler T, Brosnahan S, et al. Thromboprophylaxis in Patients with COVID- 19. A Brief Update to the CHEST Guideline and Expert Panel Report. Chest. Feb 12 2022;doi:10.1016/j.chest.2022.02.006


16. Spyropoulos AC, Levy JH, Ageno W, et al. Scientific and Standardization Committee communication: Clinical guidance on the diagnosis, prevention, and treatment of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. Aug 2020;18(8):1859-1865. doi:10.1111/jth.14929


17. Lee KS, Talenfeld AD, Browne WF, et al. Role of interventional radiology in the treatment of COVID-19 patients: Early experience from an epicenter. Clin Imaging. Mar 2021;71:143-146. doi:10.1016/j.clinimag.2020.10.048


18. Uberoi R, Hausegger K. COVID 19: Re-evaluation of Interventional Radiology. Cardiovasc Intervent Radiol. Jun 2021;44(6):883-884. doi:10.1007/ s00270-020-02765-2


19. Updates on Thrombosis with Thrombocytopenia Syndrome (TTS). ACIP Meeting December 16, 2021. https://www.cdc.gov/vaccines/acip/ meetings/downloads/slides-2021-12-16/02- COVID-See-508.pdf Accessed March 1, 2022.


20. Houghton D PA, Ashrani A, Wysokinska E, Chaudhary R, Padrnos L, Pruthi RK, Sridharan M, Shah S, and Wysokinski WE. Deep Vein Thrombosis after COVID-19 Vaccinations. presented at: ASH Annual Meeting; 2021; Atlanta, GA.


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