Abstract
COVID-19 has become major public health problems, with new cases and deaths growing around the world. COVID-19 has been reportedly associated with hypercoagulable state which can lead to venous thromboembolism (VTE) formation. This condition is also associated with worse outcomes in COVID-19 patients, therefore, it is critical for clinicians to identify this condition and manage it accordingly. VTE formation in COVID-19 occurs through several mechanisms, such as inflammatory reaction leading to hypercoagulable state and vascular dysfunction, direct vascular injury by the virus, and immobilization of the patients. The rate of VTE formation is as high as 31% in ICU patients and 9.2% in general wards patients, and it is also associated with poorer prognosis. Thromboprophylaxis with heparin, particularly low molecular weight heparin (LMWH), has been shown to improve the prognosis in these patients. A careful individual assessment is required to determine which patients will benefit from this therapy, as there are still no sufficient prospective trials to establish guidelines for VTE thromboprophylaxis in COVID-19. The assessment includes laboratory parameters such as PT, platelet count, D-dimer, fibrinogen, and other risk factors incorporated in PADUA risk assessment model (RAM), versus the risk of bleeding incorporated in IMPROVE bleeding RAM.
Highlights
In December 2019, a cluster of acute atypical respiratory disease was found in Wuhan, China, followed by rapid spreading from Wuhan to other areas
COVID-19 has been reported to associate with a hypercoagulable state, which may lead to venous thromboembolism (VTE) formation
The major coagulation disorder was found in almost all patients with the condition of severe COVID-19.5 Cui et al showed that VTE was found in 25% of severe COVID-19 patients in Intensive Care Unit (ICU), and eventually, 40% of them died.[6]
Summary
In December 2019, a cluster of acute atypical respiratory disease was found in Wuhan, China, followed by rapid spreading from Wuhan to other areas. It was later found that a pathogen named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for this disease. This disease, coronavirus disease 2019 (COVID-19), kept growing as the primary health problem worldwide.[1,2] As of 20th June, this disease has infected 8.148.006 worldwide with total deaths of 462.691, while in Indonesia, it has infected 45.029 people with 2.429 dead cases. We will discuss the hypercoagulability state and venous thromboembolism (VTE) formation, how to evaluate the risk of VTE formation in COVID-19 patients, and the role of low molecular weight heparin (LMWH) in preventing this condition
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