5/16/2023 0 Comments Si aliquis7ĭDI Disclaimer: Our position in this article is not to provide comment on the advisability, efficacy, or validity of published guidelines and opinions on the management of microembolism and venous thromboembolism in the COVID-19 patient. Additionally, the Journal of the American College of Cardiology addressed thrombotic disease in COVID-19 patients and mentioned apixaban as a potential anticoagulation therapy. Interestingly, recommendations to both initiate and terminate apixaban (and similar drugs) are made at various points of the decision algorithm. These published guidelines cover a wide array of clinical situations for moderately, acutely, and critically ill COVID-19 patients. For example, a recent online article highlighted a rather complicated set of 18 separate recommendations from the American College of Chest Physicians. The clinical recommendations and clinical practice indications concerning thrombotic events from COVID-19 are multi-factorial and still evolving. 1,2 COVID-19-associated hypercoagulable states have caused serious morbidity and mortality not typically seen in younger patients. Some patients have developed novel coronavirus-induced inflammatory changes which, along with platelet activation, endothelial dysfunction, and stasis, have produced a state similar to disseminated intravascular coagulation (DIC), with increased D-Dimer and fibrin/fibrinogen degradation products. One of the most concerning developments in the ongoing and devastating worldwide COVID-19 pandemic is the emergence of serious and even life-threatening thrombotic complications in younger patients who contract the disease. This response also should not be construed as representing APSF endorsement or policy (unless otherwise stated), making clinical recommendations, or substituting for the judgment of a physician and consultation with independent legal counsel. However, this material is provided only for informational purposes and does not constitute medical or legal advice. The APSF has used its best efforts to provide accurate information. Disclaimer: Viewers of this material should review the information contained within it with appropriate medical and legal counsel and make their own determinations as to relevance to their particular practice setting and compliance with state and federal laws and regulations.
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