PMID- 32550069
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 12
IP  - 5
DP  - 2020 May 16
TI  - Anticoagulation Options for Coronavirus Disease 2019 (COVID-19)-Induced 
      Coagulopathy.
PG  - e8150
LID - 10.7759/cureus.8150 [doi]
LID - e8150
AB  - As the coronavirus disease 2019 (COVID-19) pandemic is evolving, coagulopathy 
      induced by the disease and its severe complications are raising concerns in the 
      medical community. Because coagulopathy caused by COVID-19 has been difficult to 
      control, it is important to have a better understanding of what therapies have 
      been studied thus far and what therapies have demonstrated better outcomes for 
      hospitalized patients. This review is focused on literature, research, and expert 
      clinical judgments published in 2020 with a few references to articles published 
      earlier. The review introduces the interim guidelines of the International 
      Society of Thrombosis and Haemostasis (ISTH) for management of COVID-19-induced 
      coagulopathy, discusses the efficacy of these guidelines in clinical settings, 
      and summarizes the response of the scientific community to these guidelines and 
      their clinical implications. Due to the failure of patients to respond to the 
      prophylactic doses of heparin recommended by ISTH, higher doses of heparin may be 
      necessary to achieve adequate anticoagulation. Patients' resistance to 
      prophylactic doses of heparin could be due to low levels of anti-thrombin and 
      high levels of fibrinogen, which would reinforce the use of therapeutic doses of 
      heparin in the early stages of hospitalization. The review also compares 
      low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) as 
      anticoagulant choices for COVID-19 patients. Given the complications specific to 
      COVID-19, UFH may be a better choice of anticoagulant. Outpatient anticoagulation 
      options are also reviewed. Changing qualified patients from vitamin K antagonists 
      (VKA) to direct-acting oral anticoagulant (DOAC) for the convenience of less 
      frequent monitoring may be appropriate. New anticoagulant, nafamostat, used in 
      Japan is also discussed as a possible potentiate for heparin therapy.
CI  - Copyright (c) 2020, Turshudzhyan et al.
FAU - Turshudzhyan, Alla
AU  - Turshudzhyan A
AD  - Internal Medicine, University of Connecticut Health Center, Farmington, USA.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20200516
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC7294862
OTO - NOTNLM
OT  - covid-19
OT  - d-dimer
OT  - doac
OT  - fibrinogen
OT  - low molecular weight heparin
OT  - nafamostat
OT  - platelet count
OT  - unfractionated heparin
COIS- The authors have declared that no competing interests exist.
EDAT- 2020/06/19 06:00
MHDA- 2020/06/19 06:01
PMCR- 2020/05/16
CRDT- 2020/06/19 06:00
PHST- 2020/06/19 06:00 [entrez]
PHST- 2020/06/19 06:00 [pubmed]
PHST- 2020/06/19 06:01 [medline]
PHST- 2020/05/16 00:00 [pmc-release]
AID - 10.7759/cureus.8150 [doi]
PST - epublish
SO  - Cureus. 2020 May 16;12(5):e8150. doi: 10.7759/cureus.8150.