Guidelines for prophylaxis and anti-thrombotic treatment for patients with COVID-19. Consensus of the Latin American Cooperative Group on Hemostasis and Thrombosis (CLAHT)

Cecilia Guillermo-Esposito, Cátedra de Hematología, Facultad de Medicina, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
Patricia Casais, Departamento de Epidemiología Clínica y Evidencia, Instituto de Investigaciones en Salud Pública, Universidad de Buenos Aires, Argentina
Gabriela Cesarman-Maus, Departamento de Hematología, Instituto Nacional de Cancerología, Ciudad de México, México
Fernanda Andrade-Orsi, Departamento de Patología Clínica, Escuela de Ciencias Médicas, Universidad de Campinas, Campinas-Sao Paulo, Brasil
Rosario Martínez-Rovira, Unidad de Hemostasis y Trombosis, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
Joao C. de-Campos-Guerra, Hospital Israelita Albert Einstein, Centro de Hematología de Sao Paulo, Sao Paulo, Brasil
Suely M. Rezende, Facultad de Medicina, Universidad Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
Raúl Izaguirre-Ávila, Departamento de Hematología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México

Coagulopathy and thrombosis associated with coronavirus disease 2019 (COVID-19) represent a major issue in the management of this disease. In the past months, clinical studies have demonstrated that COVID-19 patients present with a particular hypercoagulable state, in which a markedly increased D-dimer concomitant with increased levels of fibrinogen are observed. This hypercoagulable state leads to an increased risk of thrombosis, which seems to be higher among those patients with critical symptoms of COVID-19. The best therapeutic approach to prevent thrombotic events in COVID-19 has not been determined yet and several questions regarding thromboprophylaxis therapy, such as the time to initiate anticoagulation, type of anticoagulant and dose regimen, have emerged among physicians. To address these concerns, several medical societies have published position papers to provide the opinion of thrombosis experts on the management of coagulopathy and thrombosis associated with COVID-19. In line with this, the Latin America Cooperative Group of Hemostasis and Thrombosis (Grupo CLAHT) has constituted a panel of experts in thrombosis and hemostasis to discuss the available data on this topic. The aim of this review is to summarize the current evidence regarding hemostatic impairment and thrombotic risk in COVID-19 and to provide a carefully revised opinion of Latin American experts on the thromboprophylaxis and management of thrombotic events and coagulopathy in patients with suspected COVID-19.

Keywords: COVID-19. Thromboprophylaxis. Thrombosis. Thromboembolism. SARS-CoV-2. Pneumonia.