Methodological Issues and Controversies in COVID-19 Coagulopathy: ATale of Two Storms

摘要

Venous thromboembolism, occlusion of dialysis catheters, circuit thrombosis inECMO devices, all in the face of prophylactic and sometimes even therapeuticanti-coagulation, are frequent features of COVID-19 coagulopathy. The trialsavailable to guide clinicians are methodologically limited. There are severalunresolved controversies including 1) Should all hospitalized patients withCOVID-19 receive prophylactic anti-coagulation? 2) Which patients should havetheir dosage escalated to intermediate dose? 3) Which patients should beconsidered for full-dose anti-coagulation even without a measurablethromboembolic event and how should that anti-coagulation be monitored? 4)Should patients receive post-discharge anti-coagulation? 5) What thromboticissues are related to the various medications being used to treat thiscoagulopathy? 6) Is anti-phospholipid anti-body part of this syndrome? 7) How dothe different treatments for this disease impact the coagulation issues? Theaims of this article are to explore these questions and interpret the availabledata based on the current evidence.