Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine

Grigoris T. Gerotziafas; Mariella Catalano; Mary-Paula Colgan; Zsolt Pecsvarady; Jean Claude Wautrecht; Bahare Fazeli; Dan-Mircea Olinic; Katalin Farkas; Ismail Elalamy; Anna Falanga; Jawed Fareed; Chryssa Papageorgiou; Rosella S. Arellano; Petros Agathagelou; Darco Antic; Luciana Auad; Ljiljana Banfic; John R. Bartolomew; Bela Benczur; Melissa B. Bernardo; Francesco Boccardo; Renate Cifkova; Benilde Cosmi; Sergio De Marchi; Evangelos Dimakakos; Meletios A. Dimopoulos; Gabriel Dimitrov; Isabelle Durand-Zaleski; Michael Edmonds; Essam Abo El Nazar; Dilek Erer; Omar L. Esponda; Paolo Gresele; Michael Gschwandtner; Yongquan Gu; Mónica Heinzmann; Naomi M. Hamburg; Amer Hamadé; Noor-Ahmed Jatoi; Oguz Karahan; Debora Karetova; Thomas Karplus; Peter Klein-Weigel; Endre Kolossvary; Matija Kozak; Eleftheria Lefkou; Gianfranco Lessiani; Aaron Liew; Antonella Marcoccia; Peter Marshang; George Marakomichelakis; Jiri Matuska; Luc Moraglia; Sergio Pillon; Pavel Poredos; Manlio Prior; David Raymund K. Salvador; Oliver Schlager; Gerit Schernthaner; Alexander Sieron; Jonas Spaak; Alex Spyropoulos; Muriel Sprynger; Dusan Suput; Agata Stanek; Viera Stvrtinova; Andrzej Szuba; Alfonso Tafur; Patrick Vandreden; Panagiotis E. Vardas; Dragan Vasic; Miikka Vikkula; Paul Wennberg; Zhenguo Zhai; Scientific Reviewer Committee

doi:10.1055/s-0040-1715798

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2020; 120(12): 1597-1628
DOI: 10.1055/s-0040-1715798

Position Paper

Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine

Grigoris T. Gerotziafas

¹Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France

²Research Group Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France

,

Mariella Catalano

³Research Center on Vascular Disease & Angiology Unit, Department of Biomedical Science, L Sacco Hospital, University of Milan, Milan, Italy

,

Mary-Paula Colgan

⁴Department of Vascular Surgery, St. James's Hospital/Trinity College Dublin, Dublin, Ireland

,

Zsolt Pecsvarady

⁵Department of Vascular Medicine, Flor Ferenc Teaching Hospital, Kistarcsa, Hungary

,

Jean Claude Wautrecht

⁶Service de Pathologie Vasculaire, Hôpital ERASME, Université Libre de Bruxelle, Brussels, Belgium

,

Bahare Fazeli

⁷Immunology Department, Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Sciences, Iran

,

Dan-Mircea Olinic

⁸Medical Clinic No. 1, University of Medicine and Pharmacy, Cluj-Napoca, Romania

,

Katalin Farkas

⁹Department of Angiology, St. Imre University Teaching Hospital, Budapest, Hungary

,

Ismail Elalamy

¹Hematology and Thrombosis Center, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de Médecine, Sorbonne Université, Paris, France

²Research Group Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France

¹⁰Department of Obstetrics and Gynecology, I.M.Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia

,

Anna Falanga

¹¹Department of Immunohematology and Transfusion Medicine, & the Thrombosis and Hemostasis Center, Hospital Papa Giovanni XXIII, Bergamo, Italy

,

Jawed Fareed

¹²Department of Pathology, Loyola University Medical Center, Maywood, Illinois, United States

,

Chryssa Papageorgiou

¹³Service Anesthésie, Réanimation et Médecine Périopératoire, Hôpital Tenon, Hôpitaux Universitaires de l'Est Parisien, Assistance Publique Hôpitaux de Paris, Faculté de médecine, Sorbonne Université, Paris, France

,

Rosella S. Arellano

¹⁴Philippine Society of Vascular Medicine, Manila, Philippine

,

Petros Agathagelou

¹⁵Department of Inrterventional Cardiology, American Heart Institute of Cyprus, Nicosia, Cyprus

,

Darco Antic

¹⁶Clinic for Hematology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

,

Luciana Auad

¹⁷Medicina Vascular, Sanatorio Allende Córdoba, Ciencias Médicas, Universidad Católica de Córdoba, Argentina

,

Ljiljana Banfic

¹⁸University Hospital Center, School of Medicine University of Zagreb, Croatia

,

John R. Bartolomew

¹⁹Cleveland Clinic, Cleveland, Ohio, United States

,

Bela Benczur

²⁰Balassa Janos County Hospital, University Medical School, Szeged, Hungary

,

Melissa B. Bernardo

¹⁴Philippine Society of Vascular Medicine, Manila, Philippine

,

Francesco Boccardo

²¹Department of Cardio-Thoracic-Vascular and Endovascular Surgery, Unit of Lymphatic Surgery, IRCCS S. Martino Hospital, University of Genoa, Italy

,

Renate Cifkova

²²Department of Preventive Cardiology, Thomayer Teaching Hospital, Prague, Czech Republic

,

Benilde Cosmi

²³Angiology and Blood Coagulation, Department of Specialty, Diagnostic and Experimental Medicine, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy

,

Sergio De Marchi

²⁴Angiology Unit, Cardiovascular and Thoracic and Medicine Department, Verona University Hospital, Verona, Italy

,

Evangelos Dimakakos

²⁵Vascular Unit of 3rd Department of Internal Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece

,

Meletios A. Dimopoulos

²⁶Hellenic Society of Hematology, Athens, Greece

²⁷Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

,

Gabriel Dimitrov

³Research Center on Vascular Disease & Angiology Unit, Department of Biomedical Science, L Sacco Hospital, University of Milan, Milan, Italy

,

Isabelle Durand-Zaleski

²⁸Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l'Hôtel Dieu, Paris, France

,

Michael Edmonds

²⁹Diabetic Foot Clinic, King's College Hospital, London, United Kingdom

,

Essam Abo El Nazar

³⁰Departement of Surgery, Ministry of Health, Saudi Arabia

,

Dilek Erer

³¹Department of Cardiovascular Surgery, Faculty of Medicine, Gazi University, Besevler/Ankara, Turkey

,

Omar L. Esponda

³²Internal Medicine Department, Hospital Perea, Mayaguez, Puerto Rico, United States

,

Paolo Gresele

³³Section of Internal and Cardiovascular Medicine, Department of Medicine, -University of Perugia, Perugia, Italy

,

Michael Gschwandtner

³⁴MedizinischeUniverstiät Wien, Universitätsklinik für Innere Medizin II, Klinische Abteilung für Angiologie, Vienna, Austria

,

Yongquan Gu

³⁵Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing China

,

Mónica Heinzmann

¹⁷Medicina Vascular, Sanatorio Allende Córdoba, Ciencias Médicas, Universidad Católica de Córdoba, Argentina

,

Naomi M. Hamburg

³⁶The Whitaker Cardiovascular Institute Department of Medicine Boston University School of Medicine, Boston, Massachusetts, United States

,

Amer Hamadé

³⁷Vascular Medicine Unit, Internal Medicine Department, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia

,

Noor-Ahmed Jatoi

³⁸Department Vascular Medicine, Mulhouse Hospital Center, Mulhouse, France

,

Oguz Karahan

³⁹Department of Cardiovascular Surgery, Medical School of Alaaddin Keykubat University, Alanya/Antalya, Turkey

,

Debora Karetova

⁴⁰Second Department of Medicine, Department of Cardiovascular Medicine, Charles University in Prague, Prague, Czech Republic

,

Thomas Karplus

⁴¹Department of Vascular Medicine, Concord Repatriation General Hospital, Sydney, Australia

,

Peter Klein-Weigel

⁴²Klinik für Angiologie, Zentrum für Innere Medizin II, Ernst von Bergmann Klinikum, Potsdam, Germany

,

Endre Kolossvary

⁹Department of Angiology, St. Imre University Teaching Hospital, Budapest, Hungary

,

Matija Kozak

⁴³Department for Vascular Diseases, Medical Faculty of Ljubljana, University Medical Center Ljubljana, Ljubljana, Slovenia

,

Eleftheria Lefkou

⁴⁴Board member of the Institute for the Study and Education on Thrombosis and Antithrombotic Therapy, Athens, Greece

,

Gianfranco Lessiani

⁴⁵Angiology Unit, Internal Medicine Department., Città Sant' Angelo Hospital, AUSL 03, Pescara, Italy

,

Aaron Liew

⁴⁶Portiuncula University Hospital, Soalta University Health Care Group, National University of Ireland Galway (NUIG), Galway, Ireland

,

Antonella Marcoccia

⁴⁷Unità di Medicina Vascolare e Autoimmunità, CRIIS-Centro di riferimento interdisciplinare per la Sclerosi Sistemica, Rome, Italy

,

Peter Marshang

⁴⁸Department of Internal Medicine, Central Hospital of Bolzano, Bolzano, Italy

,

George Marakomichelakis

⁴⁹Angiology Unit, Evangelismos General Hospital, Athens, Greece

,

Jiri Matuska

⁵⁰MATMED s.r.o., Private Angiology Facility, Hodonin, Czech Republic

,

Luc Moraglia

⁵¹Angiologie Centre Cours du Médoc, Médecine Vasculaire Travail, Bordeaux, France

,

Sergio Pillon

⁵²UOSD Angiology, San Camillo-Forlanini Hospital, National Health Institute ISS, Rome, Italy

,

Pavel Poredos

⁵³Medical Association of Slovenia and SMA, Slovenia Academic Research Centre, Slovenian Medical Academy, Ljubljana, Slovenia

,

Manlio Prior

⁵⁴Angiology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy

,

David Raymund K. Salvador

¹⁴Philippine Society of Vascular Medicine, Manila, Philippine

,

Oliver Schlager

⁵⁵Division of Angiology, Department of Internal Medicine 2, Medical University of Vienna, Vienna, Austria

,

Gerit Schernthaner

⁵⁵Division of Angiology, Department of Internal Medicine 2, Medical University of Vienna, Vienna, Austria

,

Alexander Sieron

⁵⁶Department of Internal Medicine, Angiology and Physical Medicine, Medical University of Silesia, Katowice, Poland

⁵⁷Specialist Hospital, Bytom, Jan Długosz University in Częstochowa, Częstochowa, Poland

,

Jonas Spaak

⁵⁸Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Stockholm County, Sweden

,

Alex Spyropoulos

⁵⁹Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Feinstein Institute for Medical Research, New York, New York, United States

,

Muriel Sprynger

⁶⁰Cardiology Department, University Hospital Sart Tilman, Liege, Belgium

,

Dusan Suput

⁶¹Center for Clinical Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

,

Agata Stanek

⁶²Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Bytom, Poland

,

Viera Stvrtinova

⁶³Faculty of Medicine, Comenius University, Bratislava, Slovak Republic

,

Andrzej Szuba

⁶⁴Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland

,

Alfonso Tafur

⁶⁵Vascular Medicine University of Chicago, Northshore Cardiovascular Institute, Skokie, Illinois, US Army

,

Patrick Vandreden

²Research Group Cancer, Haemostasis and Angiogenesis,” INSERM U938, Centre de Recherche Saint-Antoine, Institut Universitaire de Cancérologie, Faculty of Medicine, Sorbonne University, Paris, France

,

Panagiotis E. Vardas

⁶⁶Medical School of Crete, University of Crete and Heart Sector, Hellenic Healthcare Group, Athens, Greece

,

Dragan Vasic

⁶⁷Department of Noninvasive vascular laboratory, Clinic of Vascular and Endovascular Surgery, Clinical Centre of Serbia, Belgrade, Serbia

,

Miikka Vikkula

⁶⁸Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium

,

Paul Wennberg

⁶⁹Department of Cardiovascular Medicine, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, United States

,

Zhenguo Zhai

⁷⁰Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Peking University Health Science Center, Capital Medical University, Beijing, China

⁷¹Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China

,

Scientific Reviewer Committee

› Author Affiliations

Abstract

COVID-19 is also manifested with hypercoagulability, pulmonary intravascular coagulation, microangiopathy, and venous thromboembolism (VTE) or arterial thrombosis. Predisposing risk factors to severe COVID-19 are male sex, underlying cardiovascular disease, or cardiovascular risk factors including noncontrolled diabetes mellitus or arterial hypertension, obesity, and advanced age. The VAS-European Independent Foundation in Angiology/Vascular Medicine draws attention to patients with vascular disease (VD) and presents an integral strategy for the management of patients with VD or cardiovascular risk factors (VD-CVR) and COVID-19. VAS recommends (1) a COVID-19-oriented primary health care network for patients with VD-CVR for identification of patients with VD-CVR in the community and patients' education for disease symptoms, use of eHealth technology, adherence to the antithrombotic and vascular regulating treatments, and (2) close medical follow-up for efficacious control of VD progression and prompt application of physical and social distancing measures in case of new epidemic waves. For patients with VD-CVR who receive home treatment for COVID-19, VAS recommends assessment for (1) disease worsening risk and prioritized hospitalization of those at high risk and (2) VTE risk assessment and thromboprophylaxis with rivaroxaban, betrixaban, or low-molecular-weight heparin (LMWH) for those at high risk. For hospitalized patients with VD-CVR and COVID-19, VAS recommends (1) routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication); (2) LMWH as the drug of choice over unfractionated heparin or direct oral anticoagulants for the treatment of VTE or hypercoagulability; (3) careful evaluation of the risk for disease worsening and prompt application of targeted antiviral or convalescence treatments; (4) monitoring of D-dimer for optimization of the antithrombotic treatment; and (5) evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged post-discharge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH.

Keywords

COVID-19 - cardiovascular disease - peripheral artery disease - deep vein thrombosis - antithrombotic - antiplatelets - anticoagulants - low-molecular-weight heparin - DOAC

Full Text

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