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
Authors: Gerotziafas Grigoris T. , Catalano Mariella , Colgan Mary-Paula , Pecsvarady Zsolt , Wautrecht Jean Claude , Fazeli Bahare , Olinic Dan-Mircea , Farkas Katalin , Elalamy Ismail , Falanga Anna , Fareed Jawed , Papageorgiou Chryssa , Arellano Rosella S. , Agathagelou Petros , Antic Darco , Auad Luciana , Banfic Ljiljana , Bartolomew John R. , Benczur Bela , Bernardo Melissa B. , Boccardo Francesco , Cifkova Renate , Cosmi Benilde , De Marchi Sergio , Dimakakos Evangelos , Dimopoulos Meletios A. , Dimitrov Gabriel , Durand-Zaleski Isabelle , Edmonds Michael , El Nazar Essam Abo , Erer Dilek , Esponda Omar L. , Gresele Paolo , Gschwandtner Michael , Gu Yongquan , Heinzmann Mónica , Hamburg Naomi M. , Hamadé Amer , Jatoi Noor-Ahmed , Karahan Oguz , Karetova Debora , Karplus Thomas , Klein-Weigel Peter , Kolossvary Endre , Kozak Matija , Lefkou Eleftheria , Lessiani Gianfranco , Liew Aaron , Marcoccia Antonella , Marshang Peter , Marakomichelakis George , Matuska Jiri , Moraglia Luc , Pillon Sergio , Poredos Pavel , Prior Manlio , Salvador David Raymund K. , Schlager Oliver , Schernthaner Gerit , Sieron Alexander , Spaak Jonas , Spyropoulos Alex , Sprynger Muriel , Suput Dusan , Stanek Agata , Stvrtinova Viera , Szuba Andrzej , Tafur Alfonso , Vandreden Patrick , Vardas Panagiotis E. , Vasic Dragan , Vikkula Miikka , Wennberg Paul , Zhai Zhenguo ,   Scientific Reviewer Committee
Published: September 2020

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.