ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology
A Literature Review of Pathophysiology, Clinical Manifestations, Medications and Optimal Dosage, Outpatient, and Post-hospitalization Use of Anticoagulation in COVID-19 Patients [Anatol J Cardiol]
Anatol J Cardiol. 2023; 27(5): 232-239 | DOI: 10.14744/AnatolJCardiol.2023.3023

A Literature Review of Pathophysiology, Clinical Manifestations, Medications and Optimal Dosage, Outpatient, and Post-hospitalization Use of Anticoagulation in COVID-19 Patients

Dimitrios Velissaris1, Christos Michailides1, Iosif Karalis1, Themistoklis Paraskevas1, Ioanna Koniari2, Charalampos Pierrakos3, Vasileios Karamouzos4
1Department of Internal Medicine, University Hospital of Patras, Patras, Greece
2Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
3Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium
4Intensive Care Unit, University Hospital of Patras, Patras, Greece

Since severe acute respiratory syndrome coronavirus 2 led to a world pandemic, extensive research has been conducted to identify its characteristics and form an appropriate management plan. One recognized complication of COVID-19 is coagulation defects that can lead to thromboembolic events.

We have reviewed the literature to summarize and present the latest research about the pathophysiology, clinical manifestations, anticoagulation use and appropriate dose in COVID-19 patients, as well as the effect of anticoagulation in outpatient and post-hospital settings. The pathophysiology of coagulation abnormalities in COVID-19 is not fully understood yet, but multiple mechanisms appear to be involved, such as a direct viral attack, hyperinflammation, increased immune response, blood stasis, and endothelial injury. Clinical manifestations are mainly venous thromboembolism (deep vein thrombosis and pulmonary embolism), arterial thromboembolism, ischemic stroke, central venous sinus thrombosis, and central retinal vein occlusion. Anticoagulation is widely used in hospitalized patients with COVID-19, unless it is contraindicated. Heparinoid is the main anticoagulant used. However, the appropriate dosage is still debated as research is trying to find a balance between benefits and risks. In outpatients, it appears that anticoagulation has no benefit in contrast to post-hospitalization use, where benefit could be observed in severely affected patients.

We concluded that thromboprophylaxis should be used in treating hospitalized COVID-19 patients, but the dosage is still a matter of debate. More research needs to be done on outpatient and post-hospitalized patients to derive accurate conclusions.

Keywords: Anticoagulation, coagulopathy, COVID-19, heparins, prophylactic anticoagulants

Dimitrios Velissaris, Christos Michailides, Iosif Karalis, Themistoklis Paraskevas, Ioanna Koniari, Charalampos Pierrakos, Vasileios Karamouzos. A Literature Review of Pathophysiology, Clinical Manifestations, Medications and Optimal Dosage, Outpatient, and Post-hospitalization Use of Anticoagulation in COVID-19 Patients. Anatol J Cardiol. 2023; 27(5): 232-239

Corresponding Author: Christos Michailides
Manuscript Language: English


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