Clinical Guidance of Prevention of Venous Thromboembolism in COVID-19

Abstract

The COVID-19 is frequently associated with thrombosis, mainly venous thromboembolism (VTE). Therefore, based on the questionnaire survey in Japan, we revised the Clinical Guidance of Prevention of Venous Thromboembolism in COVID-19 VTE preventive medical care guidelines for COVID-19 and propose preventive methods with reference to the medical care guides and other guidelines. “Mild disease”: Basically, anticoagulant therapy is not required and physical therapy (ambulation, lower limb exercise, elastic stockings) is the main focus. Physical therapy is the basis of VTE prevention. “Moderate disease I” (shortness of breath, pneumonia findings): Anticoagulant therapy is not required, and physical therapy (including intermittent pneumatic compression) is the main focus. “Moderate disease II” (requires oxygen administration): Consider the use of low-dose unfractionated heparin, which is a prophylactic dose. No dose adjustment by APTT measurement is required. Concomitant physical therapy during anticoagulant therapy is not mandatory. “Severe disease” (ICU management or mechanical ventilation): Administer unfractionated heparin. The dose should be a preventive dose in consideration of the risk of bleeding. Conduct continuous monitoring of D-dimer.

This guideline will be revised in the future.