PMID- 33432908
OWN - NLM
STAT- MEDLINE
DCOM- 20220201
LR  - 20220819
IS  - 1476-1645 (Electronic)
IS  - 0002-9637 (Print)
IS  - 0002-9637 (Linking)
VI  - 104
IP  - 3_Suppl
DP  - 2021 Jan 11
TI  - Pragmatic Recommendations for the Management of Anticoagulation and Venous 
      Thrombotic Disease for Hospitalized Patients with COVID-19 in Low- and 
      Middle-Income Countries.
PG  - 99-109
LID - tpmd201305 [pii]
LID - 10.4269/ajtmh.20-1305 [doi]
AB  - New studies of COVID-19 are constantly updating best practices in clinical care. 
      Often, it is impractical to apply recommendations based on high-income country 
      investigations to resource limited settings in low- and middle-income countries 
      (LMICs). We present a set of pragmatic recommendations for the management of 
      anticoagulation and thrombotic disease for hospitalized patients with COVID-19 in 
      LMICs. In the absence of contraindications, we recommend prophylactic 
      anticoagulation with either low molecular weight heparin (LMWH) or unfractionated 
      heparin (UFH) for all hospitalized COVID-19 patients in LMICs. If available, we 
      recommend LMWH over UFH for venous thromboembolism (VTE) prophylaxis to minimize 
      risk to healthcare workers. We recommend against the use of aspirin for VTE 
      prophylaxis in hospitalized COVID-19 and non-COVID-19 patients in LMICs. Because 
      of limited evidence, we suggest against the use of "enhanced" or "intermediate" 
      prophylaxis in COVID-19 patients in LMICs. Based on current available evidence, 
      we recommend against the initiation of empiric therapeutic anticoagulation 
      without clinical suspicion for VTE. If contraindications exist to chemical 
      prophylaxis, we recommend mechanical prophylaxis with intermittent pneumatic 
      compression (IPC) devices or graduated compression stockings (GCS) for 
      hospitalized COVID-19 patients in LMICs. In LMICs, we recommend initiating 
      therapeutic anticoagulation for hospitalized COVID-19 patients, in accordance 
      with local clinical practice guidelines, if there is high clinical suspicion for 
      VTE, even in the absence of testing. If available, we recommend LMWH over UFH or 
      Direct oral anticoagulants for treatment of VTE in LMICs to minimize risk to 
      healthcare workers. In LMIC settings where continuous intravenous UFH or LMWH are 
      unavailable or not feasible to use, we recommend fixed dose heparin, adjusted to 
      body weight, in hospitalized COVID-19 patients with high clinical suspicion of 
      VTE. We suggest D-dimer measurement, if available and affordable, at the time of 
      admission for risk stratification, or when clinical suspicion for VTE is high. 
      For hospitalized COVID-19 patients in LMICs, based on current available evidence, 
      we make no recommendation on the use of serial D-dimer monitoring for the 
      initiation of therapeutic anticoagulation. For hospitalized COVID-19 patients in 
      LMICs receiving intravenous therapeutic UFH, we recommend serial monitoring of 
      partial thromboplastin time or anti-factor Xa level, based on local laboratory 
      capabilities. For hospitalized COVID-19 patients in LMICs receiving LMWH, we 
      suggest against serial monitoring of anti-factor Xa level. We suggest serial 
      monitoring of platelet counts in patients receiving therapeutic anticoagulation 
      for VTE, to assess risk of bleeding or development of heparin induced 
      thrombocytopenia.
FAU - Ahmed, Hanan Y
AU  - Ahmed HY
AD  - 1Division of Pulmonary and Critical Care Medicine, College of Health Sciences, 
      Addis Ababa University, Addis Ababa, Ethiopia.
FAU - Papali, Alfred
AU  - Papali A
AD  - 2Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, 
      North Carolina.
FAU - Haile, Tewodros
AU  - Haile T
AD  - 1Division of Pulmonary and Critical Care Medicine, College of Health Sciences, 
      Addis Ababa University, Addis Ababa, Ethiopia.
FAU - Shrestha, Gentle S
AU  - Shrestha GS
AD  - 3Department of Anaesthesiology, Tribhuvan University Teaching Hospital, 
      Kathmandu, Nepal.
FAU - Schultz, Marcus J
AU  - Schultz MJ
AD  - 4Department of Intensive Care, Amsterdam University Medical Centers, Location 
      'Academic Medical Center', Amsterdam, The Netherlands.
AD  - 5Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand.
AD  - 6Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, 
      Bangkok, Thailand.
FAU - Lundeg, Ganbold
AU  - Lundeg G
AD  - 7Critical Care and Anaesthesia Department, Mongolian National University of 
      Medical Sciences, Ulan Bator, Mongolia.
FAU - Akrami, Kevan M
AU  - Akrami KM
AD  - 8Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.
AD  - 9Divisions of Infectious Disease and Critical Care Medicine, University of 
      California San Diego, San Diego, California.
CN  - COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU)
LA  - eng
GR  - D43 TW009127/TW/FIC NIH HHS/United States
PT  - Journal Article
DEP - 20210111
PL  - United States
TA  - Am J Trop Med Hyg
JT  - The American journal of tropical medicine and hygiene
JID - 0370507
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/adverse effects/therapeutic use
MH  - Blood Coagulation/drug effects
MH  - COVID-19/*complications
MH  - Developing Countries/*statistics & numerical data
MH  - *Disease Management
MH  - Heparin/therapeutic use
MH  - Hospitalization/*statistics & numerical data
MH  - Humans
MH  - *Practice Guidelines as Topic
MH  - Risk Factors
MH  - Thrombosis/drug therapy/etiology/*prevention & control
MH  - Venous Thromboembolism/drug therapy/etiology/*prevention & control
PMC - PMC7957232
COIS- GROUP MEMBERS OF THE "COVID-LMIC TASK FORCE" Heads: Alfred Papali (Atrium Health, 
      Charlotte, NC) and Marcus Schultz (Mahidol University, Bangkok, Thailand; 
      University of Oxford, Oxford, United Kingdom; Amsterdam University Medical 
      Centers, location "AMC," Amsterdam, The Netherlands). Advisors: Neill K. J. 
      Adhikari (Interdepartmental Division of Critical Care Medicine, University of 
      Toronto, Toronto, Canada), Emilie J. Calvello Hynes (University of Colorado 
      School of Medicine, Department of Emergency Medicine, Denver, CO), Martin Dunser 
      (Kepler University Hospital and Johannes Kepler University Linz, Linz, Austria), 
      and Mervyn Mer (University of the Witwatersrand, Johannesburg, South Africa). 
      Subgroup members, in alphabetical order: Andrew Achilleos (Sunnybrook Health 
      Sciences Centre, Toronto, Canada), Hanan Y. Ahmed (Department of Internal 
      Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, 
      Ethiopia), Kevan M. Akrami (Universidade Federal da Bahia, Salvador, Brazil; 
      University of California San Diego, San Diego, CA), Lia M. Barros (University of 
      Washington, Seattle, WA), B. Jason Brotherton (AIC Kijabe Hospital, Kijabe, 
      Kenya), Sopheakmoniroth Chea (Calmette Hospital, Phnom Penh, Cambodia), William 
      Checkley (The Johns Hopkins University School of Medicine and The Johns Hopkins 
      University Center for Global Health, Baltimore, MD), Elif Cizmeci 
      (Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences 
      Centre, University of Toronto, Toronto, Canada), Natalie Cobb (University of 
      Washington, Seattle, WA), Finot Debebe (Department of Emergency Medicine and 
      Critical Care, Addis Ababa University School of Medicine, Addis Ababa, Ethiopia), 
      Juliana C Ferreira (University of Sao Paulo, Sao Paulo, Brazil), Gabriela Galli 
      (University of Pittsburgh School of Medicine, Pittsburgh, PA), Tewodros Haile 
      (Department of Internal Medicine, College of Health Sciences, Addis Ababa 
      University), Bhakti Hansoti (Department of Emergency Medicine, Johns Hopkins 
      University School of Medicine, Baltimore, MD), Madiha Hashmi (Ziauddin 
      University, Karachi, Pakistan), Rebecca Inglis (Lao-Oxford-Mahosot 
      Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao 
      People's Democratic Republic and Department of Intensive Care, Oxford University 
      Hospital Trust, Oxford, United Kingdom), Burton W. Lee (Critical Care Department, 
      NIH, Bethesda, MD; Division of Pulmonary, Allergy and Critical Care, University 
      of Pittsburgh School of Medicine, Pittsburgh, PA), Faith Lelei (AIC Kijabe 
      Hospital, Kijabe, Kenya), Ganbold Lundeg (Mongolian National University of 
      Medical Sciences, Ulan Bator, Mongolia), David Misango (The Aga Khan University, 
      Nairobi, Kenya), Ary Serpa Neto (Department of Critical Care Medicine, Hospital 
      Israelita Albert Einstein, Sao Paulo, Brazil; Australian and New Zealand 
      Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, 
      Australia; Department of Intensive Care, Amsterdam University Medical Centers, 
      location "AMC," University of Amsterdam, Amsterdam, The Netherlands), Alfred 
      Papali (Atrium Health, Charlotte, NC), Casey Park (Interdepartmental Division of 
      Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 
      Toronto, Canada), Rajyabardhan Pattnaik (Ispat General Hospital, Rourkela, 
      India), Jennifer L. Pigoga (Division of Emergency Medicine, University of South 
      Africa, Cape Town, South Africa), Luigi Pisani (Department of Anesthesia and 
      Intensive Care, Miulli Regional Hospital, Acquaviva delle Fonti, Italy; Doctors 
      with Africa - CUAMM, Padova, Italy; Mahidol-Oxford Tropical Medicine Research 
      Unit (MORU), Mahidol University, Bangkok, Thailand), Elisabeth D. Riviello 
      (Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess 
      Medical Center and Harvard Medical School, Boston, MA), Kristina E. Rudd 
      (University of Pittsburgh School of Medicine, Pittsburgh, PA), Marcus Schultz 
      (Mahidol University, Bangkok, Thailand; University of Oxford, Oxford, United 
      Kingdom; Amsterdam University Medical Centers, location "AMC," Amsterdam, The 
      Netherlands), Varun U. Shetty (University of Pittsburgh Medical Center, 
      Pittsburgh, PA), Gentle S. Shrestha (Tribhuvan University Teaching Hospital, 
      Kathmandu, Nepal), Chaisith Sivakorn (Mahidol University, Salaya, Thailand), 
      Shaurya Taran (Interdepartmental Division of Critical Care Medicine, Sunnybrook 
      Health Sciences Centre, University of Toronto, Toronto, Canada), and T. Eoin West 
      (University of Washington, Seattle, WA) Group members of the subgroup 
      "Anticoagulation": Hanan Y. Ahmed (Department of Internal Medicine, College of 
      Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia), Alfred Papali 
      (Atrium Health, Charlotte, NC), Tewodros Haile (Department of Internal Medicine, 
      College of Health Sciences, Addis Ababa University), Gentle S. Shrestha 
      (Tribhuvan University Teaching Hospital, Kathmandu, Nepal), Marcus Schultz 
      (Mahidol University, Bangkok, Thailand; University of Oxford, Oxford, United 
      Kingdom; Amsterdam University Medical Centers, location "AMC," Amsterdam, The 
      Netherlands), Ganbold Lundeg (Mongolian National University of Medical Sciences, 
      Ulan Bator, Mongolia), and Kevan M. Akrami (Universidade Federal da Bahia, 
      Salvador, Brazil; University of California San Diego, San Diego, CA).
EDAT- 2021/01/13 06:00
MHDA- 2022/02/02 06:00
PMCR- 2021/01/11
CRDT- 2021/01/12 08:37
PHST- 2020/10/06 00:00 [received]
PHST- 2020/12/23 00:00 [accepted]
PHST- 2021/01/13 06:00 [pubmed]
PHST- 2022/02/02 06:00 [medline]
PHST- 2021/01/12 08:37 [entrez]
PHST- 2021/01/11 00:00 [pmc-release]
AID - tpmd201305 [pii]
AID - 10.4269/ajtmh.20-1305 [doi]
PST - epublish
SO  - Am J Trop Med Hyg. 2021 Jan 11;104(3_Suppl):99-109. doi: 10.4269/ajtmh.20-1305.