​​Антикоагулянтная терапия при COVID-19

COVID-19 is a hypercoagulable state, and the risk of thromboembolic disease is increased in critically ill (and sometimes well-appearing) individuals. Thromboembolism is typically venous but in some cases may be arterial. Bleeding is much less common but can occur, including intracerebral bleeding, highlighting the importance of documenting ischemia or thrombosis when feasible. Decisions about anticoagulation are made based on clinical criteria as illustrated above, rather than on isolated laboratory findings such as D-dimer, which is primarily used as a measure of disease severity and prognosis.

COVID-19: coronavirus disease 2019; MI: myocardial infarction; PE: pulmonary embolism; DVT: deep vein thrombosis; AF: atrial fibrillation; VTE: venous thromboembolism; tPA: tissue plasminogen activator; PERT: pulmonary embolism response team; ICU: intensive care unit; LMW: low molecular weight; CrCl: creatinine clearance; RRT: renal replacement therapy; HIT: heparin-induced thrombocytopenia.
Appropriate testing to document suspected thromboembolism is advised if feasible. Assistance from a specialist (pulmonary, critical care, hematology) may be required. Refer to UpToDate for details of testing.
¶ High-risk features include prior VTE, recent surgery or trauma, immobilization, or obesity.