The European Independent Foundation in Angiology/Vascular Medicine is a non-profit, scientific foundation dedicated to the prevention and control of vascular disease, to guarantee benefits to all patients and the whole society (1). The aims of the foundation are pursued with the help of research, education and clinical practice.
A recent position paper from the foundation and authored by Dr. Grigoris Gerotziafas et al. has been recently published in Thrombosis and Hemostasis (2).
The position paper reports a guidance for the management of patients with vascular disease or cardiovascular risk factors and COVID-19 points the attention to patients with vascular disease or cardiovascular risk factors (VD-CVR) who:
- have a personal history of arteriopathy or arterial thrombosis (ischemic stroke, carotid artery disease, coronary artery disease, peripheral artery disease or arterial thrombosis of rare localization – i.e., mesenteric artery thrombosis)
- have a history of deep vein thrombosis, pulmonary embolism (PE) or vein thrombosis of rare localization (i.e., cerebral vein thrombosis, splanchnic vein thrombosis, upper limb thrombosis)
- are obese (with BMI >30)
- suffer from diabetes mellitus or arterial hypertension
All these patients are at a high risk to develop severe COVID-19 when infected by SARS-CoV-2. The guidelines in the position paper are thought to prevent the development of venous thrombosis and to provide a guide for intervention in case of disseminated intravascular coagulation, which is often reported in association with COVID-19, by means of practical indications to be used in daily clinical practice. The goals of the document can be summarized as follows:
- Listing the basic principles helping in the organization of a primary healthcare network focused on patients with VD-CVR
- Identifying the tools to spot patients with vascular disease among patients with COVID-19 with an accurate evaluation of the risk for disease worsening
- Inform about the possible modification of antithrombotic and vascular regulating treatments efficacy by COVID-19-
- Suggesting treatment of hypercoagulable states and disseminated intravascular coagulation
- Give recommendations for the prevention and management of venous thromboembolism (VTE) specific for patients with VD-CVR
For the generation of this guideline, an extensive literature search has been performed, starting from 1 January until 14 July 2020, on PubMed and on three preprint servers (https://www.medrxiv.org, https://www.preprints.org and https://www.ssrn.com/index.cfm/en/coronavirus), using the main terms related to hypercoagulability, cardiovascular disease and coronavirus as keywords (2).
The position paper is, therefore, extremely complete in analyzing the background and the key elements of COVID-19 onset. These facts are put in relationship with hypercoagulability and endothelial stimulation, considering both coagulation and complement activation and, on such basis, the authors express general recommendations for approaching patients with vascular disease, cardiovascular risk factors and peripheral artery disease during the pandemic. Moreover, a detailed analysis of the antithrombotic treatments (use of heparins, oral anticoagulants, antiplatelet agents), possible drug–drug interactions with medications currently used for COVID-19, together with the blood-borne hypercoagulability, risk of disease worsening and VTE in COVID-19 patients are also presented.
Altogether, the indications for patient management can be summarized as follows:
- The need to organize the primary healthcare system with a solid network also with the support of eHealth technologies
- Favoring the home-based management of patients with VD-CVR and non-severe COVID-19
- Improving the management of patients with VD-CVR hospitalized for COVID-19
- The need to prevent post-hospital discharge VTE in patients with VD-CVR and COVID-19, which should be better followed and regulated
Besides the indications, it is important to underline that this guideline will be continuously updated, and reported on the VAS website (3), in accordance with the new data and epidemiological evidence coming from the clinical studies and the research. In this way, attention to the vascular and cardiovascular disease issues will be kept central both for the patients and the institutions, responsible for the management of healthcare.
Dr. Grigoris Gerotziafas, remarks the purpose and implications of this position paper in an online interview (4).
- VAS-European Independent Foundation in Angiology/ Vascular Medicine. https://www.vas-int.net/vas-for-angiology-vascular-medicine/
- Gerotziafas GT, Catalano M, Colgan MP, et al; Scientific Reviewer Committee. 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. Thromb Haemost. 2020. doi: 10.1055/s-0040-1715798. Epub ahead of print. PMID: 32920811.