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; Behnood Bikdeli; Yutao Guo; Job Harenberg; Yu Hu; Gregory Y.H. Lip; Vanessa Roldan

doi:10.1055/s-0040-1715798

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. BernardoFrancesco 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, Behnood Bikdeli, Yutao Guo, Job Harenberg, Yu Hu, Gregory Y.H. Lip, Vanessa Roldan

Research output: Contribution to journal › Review article › peer-review

139 Scopus citations

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.

Original language	English
Pages (from-to)	1597-1628
Number of pages	32
Journal	Thrombosis and Haemostasis
Volume	120
Issue number	12
DOIs	https://doi.org/10.1055/s-0040-1715798
State	Published - 1 Dec 2020
Externally published	Yes

Keywords

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

Access to Document

10.1055/s-0040-1715798

Cite this

Gerotziafas, G. T., Catalano, M., Colgan, M. P., Pecsvarady, Z., Wautrecht, J. C., Fazeli, B., Olinic, D. M., Farkas, K., Elalamy, I., Falanga, A., Fareed, J., Papageorgiou, C., Arellano, R. S., Agathagelou, P., Antic, D., Auad, L., Banfic, L., Bartolomew, J. R., Benczur, B., ... Roldan, V. (2020). 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. Thrombosis and Haemostasis, 120(12), 1597-1628. https://doi.org/10.1055/s-0040-1715798

@article{d18779e94bfb4e9fbbe9dbf39676edaf,

title = "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",

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

author = "Gerotziafas, {Grigoris T.} and Mariella Catalano and Colgan, {Mary Paula} and Zsolt Pecsvarady and Wautrecht, {Jean Claude} and Bahare Fazeli and Olinic, {Dan Mircea} and Katalin Farkas and Ismail Elalamy and Anna Falanga and Jawed Fareed and Chryssa Papageorgiou and Arellano, {Rosella S.} and Petros Agathagelou and Darco Antic and Luciana Auad and Ljiljana Banfic and Bartolomew, {John R.} and Bela Benczur and Bernardo, {Melissa B.} and Francesco Boccardo and Renate Cifkova and Benilde Cosmi and {De Marchi}, Sergio and Evangelos Dimakakos and Dimopoulos, {Meletios A.} and Gabriel Dimitrov and Isabelle Durand-Zaleski and Michael Edmonds and {El Nazar}, {Essam Abo} and Dilek Erer and Esponda, {Omar L.} and Paolo Gresele and Michael Gschwandtner and Yongquan Gu and M{\'o}nica Heinzmann and Hamburg, {Naomi M.} and Amer Hamad{\'e} and Jatoi, {Noor Ahmed} and Oguz Karahan and Debora Karetova and Thomas Karplus and Peter Klein-Weigel and Endre Kolossvary and Matija Kozak and Eleftheria Lefkou and Gianfranco Lessiani and Aaron Liew and Antonella Marcoccia and Peter Marshang and George Marakomichelakis and Jiri Matuska and Luc Moraglia and Sergio Pillon and Pavel Poredos and Manlio Prior and Salvador, {David Raymund K.} and Oliver Schlager and Gerit Schernthaner and Alexander Sieron and Jonas Spaak and Alex Spyropoulos and Muriel Sprynger and Dusan Suput and Agata Stanek and Viera Stvrtinova and Andrzej Szuba and Alfonso Tafur and Patrick Vandreden and Vardas, {Panagiotis E.} and Dragan Vasic and Miikka Vikkula and Paul Wennberg and Zhenguo Zhai and Behnood Bikdeli and Yutao Guo and Job Harenberg and Yu Hu and Lip, {Gregory Y.H.} and Vanessa Roldan",

year = "2020",

month = dec,

day = "1",

doi = "10.1055/s-0040-1715798",

language = "English",

volume = "120",

pages = "1597--1628",

journal = "Thrombosis and Haemostasis",

issn = "0340-6245",

publisher = "Georg Thieme Verlag",

number = "12",

}

Gerotziafas, GT, Catalano, M, Colgan, MP, Pecsvarady, Z, Wautrecht, JC, Fazeli, B, Olinic, DM, Farkas, K, Elalamy, I, Falanga, A, Fareed, J, Papageorgiou, C, Arellano, RS, Agathagelou, P, Antic, D, Auad, L, Banfic, L, Bartolomew, JR, Benczur, B, Bernardo, MB, Boccardo, F, Cifkova, R, Cosmi, B, De Marchi, S, Dimakakos, E, Dimopoulos, MA, Dimitrov, G, Durand-Zaleski, I, Edmonds, M, El Nazar, EA, Erer, D, Esponda, OL, Gresele, P, Gschwandtner, M, Gu, Y, Heinzmann, M, Hamburg, NM, Hamadé, A, Jatoi, NA, Karahan, O, Karetova, D, Karplus, T, Klein-Weigel, P, Kolossvary, E, Kozak, M, Lefkou, E, Lessiani, G, Liew, A, Marcoccia, A, Marshang, P, Marakomichelakis, G, Matuska, J, Moraglia, L, Pillon, S, Poredos, P, Prior, M, Salvador, DRK, Schlager, O, Schernthaner, G, Sieron, A, Spaak, J, Spyropoulos, A, Sprynger, M, Suput, D, Stanek, A, Stvrtinova, V, Szuba, A, Tafur, A, Vandreden, P, Vardas, PE, Vasic, D, Vikkula, M, Wennberg, P, Zhai, Z, Bikdeli, B, Guo, Y, Harenberg, J, Hu, Y, Lip, GYH & Roldan, V 2020, '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', Thrombosis and Haemostasis, vol. 120, no. 12, pp. 1597-1628. https://doi.org/10.1055/s-0040-1715798

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. / Gerotziafas, Grigoris T.; Catalano, Mariella; Colgan, Mary Paula et al.
In: Thrombosis and Haemostasis, Vol. 120, No. 12, 01.12.2020, p. 1597-1628.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19

T2 - Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine

AU - Gerotziafas, Grigoris T.

AU - Catalano, Mariella

AU - Colgan, Mary Paula

AU - Pecsvarady, Zsolt

AU - Wautrecht, Jean Claude

AU - Fazeli, Bahare

AU - Olinic, Dan Mircea

AU - Farkas, Katalin

AU - Elalamy, Ismail

AU - Falanga, Anna

AU - Fareed, Jawed

AU - Papageorgiou, Chryssa

AU - Arellano, Rosella S.

AU - Agathagelou, Petros

AU - Antic, Darco

AU - Auad, Luciana

AU - Banfic, Ljiljana

AU - Bartolomew, John R.

AU - Benczur, Bela

AU - Bernardo, Melissa B.

AU - Boccardo, Francesco

AU - Cifkova, Renate

AU - Cosmi, Benilde

AU - De Marchi, Sergio

AU - Dimakakos, Evangelos

AU - Dimopoulos, Meletios A.

AU - Dimitrov, Gabriel

AU - Durand-Zaleski, Isabelle

AU - Edmonds, Michael

AU - El Nazar, Essam Abo

AU - Erer, Dilek

AU - Esponda, Omar L.

AU - Gresele, Paolo

AU - Gschwandtner, Michael

AU - Gu, Yongquan

AU - Heinzmann, Mónica

AU - Hamburg, Naomi M.

AU - Hamadé, Amer

AU - Jatoi, Noor Ahmed

AU - Karahan, Oguz

AU - Karetova, Debora

AU - Karplus, Thomas

AU - Klein-Weigel, Peter

AU - Kolossvary, Endre

AU - Kozak, Matija

AU - Lefkou, Eleftheria

AU - Lessiani, Gianfranco

AU - Liew, Aaron

AU - Marcoccia, Antonella

AU - Marshang, Peter

AU - Marakomichelakis, George

AU - Matuska, Jiri

AU - Moraglia, Luc

AU - Pillon, Sergio

AU - Poredos, Pavel

AU - Prior, Manlio

AU - Salvador, David Raymund K.

AU - Schlager, Oliver

AU - Schernthaner, Gerit

AU - Sieron, Alexander

AU - Spaak, Jonas

AU - Spyropoulos, Alex

AU - Sprynger, Muriel

AU - Suput, Dusan

AU - Stanek, Agata

AU - Stvrtinova, Viera

AU - Szuba, Andrzej

AU - Tafur, Alfonso

AU - Vandreden, Patrick

AU - Vardas, Panagiotis E.

AU - Vasic, Dragan

AU - Vikkula, Miikka

AU - Wennberg, Paul

AU - Zhai, Zhenguo

AU - Bikdeli, Behnood

AU - Guo, Yutao

AU - Harenberg, Job

AU - Hu, Yu

AU - Lip, Gregory Y.H.

AU - Roldan, Vanessa

PY - 2020/12/1

Y1 - 2020/12/1

N2 - 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.

AB - 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.

KW - COVID-19

KW - DOAC

KW - anticoagulants

KW - antiplatelets

KW - antithrombotic

KW - cardiovascular disease

KW - deep vein thrombosis

KW - low-molecular-weight heparin

KW - peripheral artery disease

UR - http://www.scopus.com/inward/record.url?scp=85091480130&partnerID=8YFLogxK

U2 - 10.1055/s-0040-1715798

DO - 10.1055/s-0040-1715798

M3 - Review article

C2 - 32920811

AN - SCOPUS:85091480130

SN - 0340-6245

VL - 120

SP - 1597

EP - 1628

JO - Thrombosis and Haemostasis

JF - Thrombosis and Haemostasis

IS - 12

ER -

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

Abstract

Keywords

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