Some Covid 19 patients get pulmonary embolism although they are fully anticoagulated.
- Are there any prophylactic considerations rather than a full dose of LMWH/ Unfractionated Heparin?
- Is it appropriate to add anti-platelet agents "beside anticoagulants" as a routine for covid patients?
Thanks in advance.
There were some studies that discussed this issue and found that its better to keep the patient on prophylactic dose of anticoagulation as this will minimize the risk of bleeding, however, it no difference in thrombosis risk.
There was one small study showed benefit of adding aspirin to COVID 19 pts, but no other studies showed benefit.
Role of anticoagulation in COVID-19 is still a debated area. Anticoagulation in severe COVID-19 is required (LMWH/UFH). However no role of Anti-platelet drugs to prevent thrombotic events.
What is more controversial is post-discharge anticoagulation....some of these patients may develop thrombotic events few weeks or months later. Further evidences are required to establish the utility of anti platelets in that group.
It is important to recognise that a few patients with COVID-19 may develop heparin-induced thrombocytopenia which also causes thrombosis. This may be treated with alternative anticoagulants including fondaparinux and the direct oral anticoagulants.