Version 9.0 12.12.

20
© Copyright 2020 The General Hospital Corporation. All Rights Reserved.

This document was prepared (in November-December 2020) by and for MGH medical professionals (a.k.a. clinicians, care
givers) and is being made available publicly for informational purposes only, in the context of a public health emergency
related to COVID-19 (a.k.a. the coronavirus) and in connection with the state of emergency declared by the Governor of the
Commonwealth of Massachusetts and the President of the United States. It is neither an attempt to substitute for the practice of
medicine nor as a substitute for the provision of any medical professional services. Furthermore, the content is not meant to be
complete, exhaustive, or a substitute for medical professional advice, diagnosis, or treatment. The information herein should
be adapted to each specific patient based on the treating medical professional’s independent professional judgment and
consideration of the patient’s needs, the resources available at the location from where the medical professional services are
being provided (e.g., healthcare institution, ambulatory clinic, physician’s office, etc.), and any other unique circumstances.
This information should not be used to replace, substitute for, or overrule a qualified medical professional’s judgment.

This website may contain third party materials and/or links to third party materials and third party websites for your
information and convenience. Partners is not responsible for the availability, accuracy, or content of any of those third party
materials or websites nor does it endorse them. Prior to accessing this information or these third party websites you may be
asked to agree to additional terms and conditions provided by such third parties which govern access to and use of those
websites or materials.

Hematology Recommendations and Dosing Guidelines during COVID-19

Page 1-4: Recommendations
Page 5: Dosing Guidelines
Page 6-7: References

Note: Research on COVID 19 is emerging rapidly. As such, this document is fluid and will be updated
regularly. An important thread in all of these recommendations is to take an individualized approach to
patient management and a call for prospective randomized clinical trials to address important
anticoagulation issues in this population.

I. Recommendations
a. Diagnostics: For all patients presenting to MGH for COVID-19:
i. Obtain baseline: D-dimer, PT, PTT, fibrinogen, ferritin, LDH, troponin, CPK,
CK and CBC with differential
b. Monitoring
i. Trend D-dimer daily (or whenever labs are being drawn if less frequent) if baseline
or subsequent >1000 ng/mL. (A,B,D,E) [1-6]
ii. For patients in the ICU, trend CBC, PT, PTT and fibrinogen daily (or whenever labs
are being drawn if less frequent) (D,E) [6-11]
c. Management
i. All patients admitted to MGH for COVID-19 (including non-critically ill) should
receive standard prophylactic anticoagulation with LMWH (see Dosing
Guidelines, [12]) in the absence of any contraindications (active bleeding or platelet
count less than 25,000); monitoring advised in severe renal impairment; abnormal PT
or APTT is not a contraindication (C) [13-18]
1. If CrCl >30mL/min – use Lovenox 40mg sc daily
2. If CrCl <30mL/min) – use UFH (see Dosing Guidelines).

12/12/20 1 Version 9.0

Version 9.0 12.12.20
© Copyright 2020 The General Hospital Corporation. All Rights Reserved.

3. In obese patients (BMI >40 kg/m2 or >120 kg), the recommended dose is 40
mg bid (for renal failure, see Dosing Guidelines)
4. If history of HIT or HITT, use non heparin alternative.
5. If anticoagulation is contraindicated, patients should have mechanical
prophylaxis (eg: pneumoboots).

ii. Patients admitted to MGH who are on a direct oral anticoagulant or warfarin as an
outpatient (eg. for atrial fibrillation, h/o VTE, prosthetic valves) should be switched
to therapeutic dose of LMWH (preferred over UFH to decrease blood draws to
monitor PTT) due to possible interactions with COVID 19 treatments. [9]

iii. If patient has a confirmed acute DVT or PE or was on therapeutic anticoagulation

prior to hospitalization and now changed to parenteral, the following guidelines are
recommended:
1. LMWH is preferred, to minimize blood draws and has superior efficancy in
critical care population [19-20]. (See Dosing Guidelines for special
popultions and alternatives for renal failure)
2. Patients who need to be on Unfractionated Heparin (instead of LMWH)
should be monitored with antiXa levels (as opposed to PTT given that the
latter increases in severely ill COVID-19 patients and may render the PTT
unreliable).

iv. Page the inpatient Hematology Consult attending at any time to discuss specific
guidance if a patient’s coagulopathy appears to be worsening or to discuss enhanced
or changed treatment approach.

v. Whether or not COVID-19 infected patients have a unique increased risk of VTE
compared to other critical infections/processes is not currently known, and is an area
of active research. [3-6, 21-27] At this time, we do not suggest escalating
prophylactic dose of anticoagulation. Several randomized controlled trial are
currently addressing this question, and we encourage participation for eligible
patients. At MGH, the trial, A Randomized, Open-Label Trial of Therapeutic
Anticoagulation in COVID-19 Patients with an Elevated D-Dimer, is open and
enrolling.

vi. We suggest limiting therapeutic anticoagulation to the following COVID-19 patients:

1. Documented acute DVT/PE (see next section)
2. Pre-hospitalization management with therapeutic anticoagulation (as for
Afib, certain mechanical heart valves, recurrent VTE, etc)
Note: Please contact renal for CVVH related clotting protocol

12/12/20 2 Version 9.0

Version 9.0 12.12.20
© Copyright 2020 The General Hospital Corporation. All Rights Reserved.

vii. Currently, there is insufficient data to suggest using more advanced therapies (such
as TPA) in critically ill COVID-19 patients without other indication, and we do not
recommend it at this time. Trials are underway investigating these agents.

viii. Currently, the risk-benefit ratio of postdischarge thromboprophylaxis remains

uncertain and there is insufficient data to recommend routine venous
thromboprophylaxis post-discharge in patients with COVID without a clear
indication (eg. major surgery). (F) [28-30] Trial addressing this issue are underway.

d. Evaluation for suspected VTE

i. Concern for DVT: Obtain venous Doppler study, if possible, to evaluate asymmetric
limb pain or edema. If DVT is present, start full dose anticoagulation (LMWH
preferred, see Dosing Guidelines). If patient is unable to get US due to concern of
staff exposure to COVID-19, and clinical suspicion for DVT is high, we would
suggest treating with full dose anticoagulation (unless contraindicated) (see
Dosing Guidelines). Feel free to page the inpatient Hematology Consult attending for
any guidance.

ii. Concern for PE: This is a challenge given the inherent hypoxia and perturbed
coagulation profile of COVID-19 infected patients.
1. Consider PE in the case of:
a. Marked increase/rising Ddimer from priors AND
b. Acute worsening of oxygenation, blood pressure, tachycardia with
imaging findings NOT consistent with worsening COVID-19 PNA
2. During the COVID pandemic, standard diagnostic evaluation (CTA,
ECHO) may not be possible.
a. if possible, obtain US and if + DVT, treat with full dose
anticoagulation or
b. if possible, obtain point of care ECHO and if evidence of acute,
otherwise unexplained right heart strain and high clinical suspicious
for PE, or intra-cardiac thrombous, treat with full dose
anticoagulation.
c. If patient unable to get US or ECHO due to concern of staff
exposure to COVID-19 and clinical suspicion for PE remains high,
we would suggest treating with full dose anticoagulation (unless
contraindicated) (see Dosing Guidelines).
3. Using a multidisciplinary approach, as offered by the Pulmonary Embolism
Response Team (PERT), can greatly assist in these complicated patients.
[31]

e. Bleeding concerns
i. Currently, there is limited data available regarding bleeding issues in the setting of
COVID-19. (G) [3,26,32] If bleeding does develop, similar principles to septic
12/12/20 3 Version 9.0
Version 9.0 12.12.20
© Copyright 2020 The General Hospital Corporation. All Rights Reserved.

coagulopathy as per the ISTH guidelines with respect to blood transfusions may be
followed. [6]

II. Heme Contact

Please contact the Hematology Consult Attending for any coagulation-related COVID-19 issues or
questions.

Notes:

(A) D-dimer
• It is already well-established that older individuals and those who have co-morbidities (both groups tend to have
higher D-dimer) are more likely to die from COVID-19 infection. [1]
• Studies specifically looking at abnormal coagulation parameters have identified markedly elevated D-dimers as one of
the predictors of mortality. [2,3,4,5,6]
• Al-Samkari and colleagues demonstrated that elevated D-dimer at initial presentation was predictive of coagulation-
associated complications during hospitalization (D-dimer >2500 ng/mL, adjusted odds ratio [OR] for thrombosis, 6.79
[95% CI, 2.39-19.30]; adjusted OR for bleeding, 3.56 [95% CI, 1.01-12.66]), critical illness, and death. [3]
• Huang and colleagues showed that D-dimer levels on admission were higher in patients needing critical care support
(median [range] D-dimer level 2400 ng/mL[600–14,400]) than those patients who did not require it (median [range]
D-dimer level 0·5 ng/nL [300–800], p=0·0042). [4]
• Zhou and colleagues showed that elevated D-dimer levels (>1g/L) were strongly associated with in-hospital death
(OR 18.4 95% CI 2.6-128.6, p=0.003) [5]

Comments regarding D-dimer: When thrombin is activated, it cleaves fibrinogen into fibrin. The fibrin then polymerizes and is
cross-linked by Factor XIII. When such a fibrin clot is generated in any disorder, microvascular or macrovascular, the
fibrinolytic system is activated, and plasmin cleaves the cross-linked fibrin into smaller pieces which are the D-dimers.
Therefore, the D-dimer reflects the production of cross-linked fibrin and is also affected by hepatic function; D-dimers are
cleared by a normal liver but rise with liver dysfunction.

(B) DIC
• Tang et al noted development of DIC on day 4 in 71.4% of patients who didn’t survive the infection compared to just
1 patient (0.6%) who survived. Researchers also noted a statistically significant increase in D-dimer levels, and PT
with a decrease in fibrinogen levels in non-survivors at days 10 and 14. [2,6]

(C) LMWH
• LMWH protects critically ill patients against venous thromboembolism. In addition, LMWH has been shown to have
anti-inflammatory properties which may be an added benefit in COVID infection where proinflammatory cytokines
are markedly raised. [1,4,9,18,19]. See dosing instructions below. [12]

(D) Monitoring
• Multi-organ failure is more likely in patients with sepsis if they develop coagulopathy and inhibiting thrombin
generation may have benefit in reducing mortality. [7,8,9]. As noted in (B), this evidence suggests that monitoring PT,
D-dimer, platelet count and fibrinogen can be helpful in determining prognosis in COVID-19 patients and if there is
worsening of these parameters, more aggressive critical care support is warranted and consideration should be given
for more ‘experimental’ therapies in and blood product support as appropriate [2,4,9]

(E) Thrombocytopenia

12/12/20 4 Version 9.0

Version 9.0 12.12.20
© Copyright 2020 The General Hospital Corporation. All Rights Reserved.

• Subgroup analysis comparing patients by survival noted lower platelet count correlated with mortality.
Thrombocytopenia was also associated with over five-fold increased risk of severe COVID-19 illness (OR, 5.1; 95%
CI, 1.8-14.6). This suggests thrombocytopenia at presentation may be prognosticator.[11]
• Al-Samkari and collaeagues showed that thrombocytopenia (platelet count <150 × 109/L) and elevations in D-dimer
>2500 ng/mL at initial presentation were predictive of bleeding complications during hospitalization (in multivariable
analysis, for platelet count <150 × 109/L: OR, 2.90; 95% CI, 1.05-7.99; and for D-dimer >2500 ng/mL: OR, 3.56;
95% CI, 1.01-12.66). [3]

(F) Post-discharge prophylaxis

• The rates of thrombosis and hemorrhage appear to be similar following hospital discharge for COVID. Patell and
colleagues showed that the cumulative incidence of VTE alone at day 30 postdischarge was 0.6% (95% CI, 0.1-4.6).
The 30-day cumulative incidence of major hemorrhage was 0.7% (95% CI, 0.1-5.1) and of clinically relevant
nonmajor bleeds was 2.9% (95% CI, 1.0-9.1). These findings emphasize the need for randomized data to inform
recommendations for universal postdischarge thromboprophylaxis. [28]
• Roberts and colleagues demonstrated that COVID hospitalization does not appear to increase the risk of postdischarge
hospital-associated VTE (HA-VTE) compared with hospitalization with other acute medical illness. Following 1877
hospital discharges associated with COVID, 9 episodes of HA-VTE were diagnosed within 42 days, giving a
postdischarge rate of 4.8 per 1000 discharges. [29]
• Hill and colleagues reported that after a median follow-up of 14.6 days, VTE had been diagnosed in 3 of the 2075
admitted who were discharged alive (0.14%). Pending further evidence from prospective, controlled trials, their
findings support a traditional approach to primary VTE prevention in patients with COVID-19. [30]

(G) Bleeding Complications

• In an autopsy study of 82 patients, Zhang and colleagues found that hemorrhage accounted for 6.1% of the deaths and
hemorrhagic damage was found in 80.5% of patients. [21]
• Fraisse and colleagues reported on 92 patients with COVID and found a 21% rate of significant hemorrhagic events,
with most of them occurring in patients with full-dose anticoagulation; however, half of the patients were treated with
full-dose preemptive anticoagulation without a confirmed TE. [22]

12/12/20 5 Version 9.0

Version 9.0 12.12.20
© Copyright 2020 The General Hospital Corporation. All Rights Reserved.

Dosing Guidelines (see attached charts) [12]

12/12/20 6 Version 9.0

Version 9.0 12.12.20
© Copyright 2020 The General Hospital Corporation. All Rights Reserved.

References
1. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY,
Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P,
Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS; China Medical Treatment Expert
Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Apr
30;382(18):1708-1720. doi: 10.1056/NEJMoa2002032. Epub 2020 Feb 28. PMID: 32109013; PMCID: PMC7092819.
2. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel
coronavirus pneumonia. J Thromb Haemost. 2020 Apr;18(4):844-847. doi: 10.1111/jth.14768. Epub 2020 Mar 13. PMID:
32073213; PMCID: PMC7166509.
3. Al-Samkari H, Karp Leaf RS, Dzik WH, Carlson JCT, Fogerty AE, Waheed A, Goodarzi K, Bendapudi PK, Bornikova L,
Gupta S, Leaf DE, Kuter DJ, Rosovsky RP. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-
CoV-2 infection. Blood. 2020 Jul 23;136(4):489-500. doi: 10.1182/blood.2020006520. PMID: 32492712; PMCID:
PMC7378457.
4. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X,
Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of
patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497-506. doi:
10.1016/S0140-6736(20)30183-5. Epub 2020 Jan 24. Erratum in: Lancet. 2020 Jan 30;: PMID: 31986264; PMCID:
PMC7159299.
5. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S,
Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China:
a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. doi: 10.1016/S0140-6736(20)30566-3. Epub
2020 Mar 11. Erratum in: Lancet. 2020 Mar 28;395(10229):1038. Erratum in: Lancet. 2020 Mar 28;395(10229):1038.
PMID: 32171076; PMCID: PMC7270627.
6. Wada H, Thachil J, Di Nisio M, Mathew P, Kurosawa S, Gando S, et al. Guidance for diagnosis and treatment of DIC from
harmonization of the recommendations from three guidelines. The Scientific Standardization Committee on DIC of the
International Society on Thrombosis Haemostasis. J Thromb Haemost. 2013 Feb 4. doi: 10.1111/jth.12155.
7. Shankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS, et al; Sepsis Definitions Task Force.
Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus
Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):775-87
8. Iba T, Levy JH, Warkentin TE, Thachil J, van der Poll T, Levi M; Scientific and Standardization Committee on DIC, and the
Scientific and Standardization Committee on Perioperative and Critical Care of the International Society on Thrombosis and
Haemostasis. Diagnosis and management of sepsis-induced coagulopathy and disseminated intravascular coagulation. J
Thromb Haemost. 2019 Nov;17(11):1989-1994.
9. Thachil J, Tang, N, Gando S et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19.
JTH. March 27, 2020.
10. American Society of Hematology. COVID-19 and coagulopathy: frequently asked questions. June 23, 2020 2020.
https://www.hematology.org/covid-1 9/covid-19-and-coagulopathy (Version 4.0; last updated September 24, 2020)
11. Lippi G, Plebani M, Michael Henry B. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19)
infections: A meta-analysis. Clin Chim Acta. 2020 Mar 13. pii: S0009- 8981(20)30124-8.
12. Rosovsky RP, Barra ME, Roberts RJ, et al. When Pigs Fly: A Multidisciplinary Approach to Navigating a Critical Heparin
Shortage [published online ahead of print, 2020 Mar 10]. Oncologist. 2020;10.1634/theoncologist.2019-0910.
doi:10.1634/theoncologist.2019-0910
13. Moores LK, Tritschler T, Brosnahan S, Carrier M, Collen JF, Doerschug K, Holley AB, Jimenez D, Le Gal G, Rali P, Wells
P. Prevention, Diagnosis, and Treatment of VTE in Patients With Coronavirus Disease 2019: CHEST Guideline and Expert
Panel Report. Chest. 2020 Sep;158(3):1143-1163. doi: 10.1016/j.chest.2020.05.559. Epub 2020 Jun 2. PMID: 32502594;
PMCID: PMC7265858.
14. Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, Nigoghossian C, Ageno W, Madjid M, Guo Y, Tang
LV, Hu Y, Giri J, Cushman M, Quéré I, Dimakakos EP, Gibson CM, Lippi G, Favaloro EJ, Fareed J, Caprini JA, Tafur AJ,
Burton JR, Francese DP, Wang EY, Falanga A, McLintock C, Hunt BJ, Spyropoulos AC, Barnes GD, Eikelboom JW,
Weinberg I, Schulman S, Carrier M, Piazza G, Beckman JA, Steg PG, Stone GW, Rosenkranz S, Goldhaber SZ, Parikh SA,
Monreal M, Krumholz HM, Konstantinides SV, Weitz JI, Lip GYH; Global COVID-19 Thrombosis Collaborative Group,
Endorsed by the ISTH, NATF, ESVM, and the IUA, Supported by the ESC Working Group on Pulmonary Circulation and
Right Ventricular Function. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention,

12/12/20 7 Version 9.0

Version 9.0 12.12.20
© Copyright 2020 The General Hospital Corporation. All Rights Reserved.

Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Jun 16;75(23):2950-
2973. doi: 10.1016/j.jacc.2020.04.031. Epub 2020 Apr 17. PMID: 32311448; PMCID: PMC7164881.
15. Spyropoulos AC, Levy JH, Ageno W, Connors JM, Hunt BJ, Iba T, Levi M, Samama CM, Thachil J, Giannis D, Douketis
JD; Subcommittee on Perioperative, Critical Care Thrombosis, Haemostasis of the Scientific, Standardization Committee of
the International Society on Thrombosis and Haemostasis. Scientific and Standardization Committee communication:
Clinical guidance on the diagnosis, prevention, and treatment of venous thromboembolism in hospitalized patients with
COVID-19. J Thromb Haemost. 2020 Aug;18(8):1859-1865. doi: 10.1111/jth.14929. PMID: 32459046; PMCID:
PMC7283841.
16. Barnes GD, Burnett A, Allen A, Blumenstein M, Clark NP, Cuker A, Dager WE, Deitelzweig SB, Ellsworth S, Garcia D,
Kaatz S, Minichiello T. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical
guidance from the anticoagulation forum. J Thromb Thrombolysis. 2020 Jul;50(1):72-81. doi: 10.1007/s11239-020-02138-z.
PMID: 32440883; PMCID: PMC7241581.
17. American Society of Hematology. COVID-19 and VTE/anticoagulation: frequently asked questions. June 23, 2020 2020.
https://www.hematology. org/covid-19/covid-19-and-vte-anticoagulation (Version 5.0; last updated September 18, 2020)
18. Flaczyk A, Rosovsky RP, Reed CT, Bankhead-Kendall BK, Bittner EA, Chang MG. Comparison of published guidelines for
management of coagulopathy and thrombosis in critically ill patients with COVID 19: implications for clinical practice and
future investigations. Crit Care. 2020 Sep 16;24(1):559. doi: 10.1186/s13054-020-03273-y. PMID: 32938471; PMCID:
PMC7492793.
19. Poterucha TJ, Libby P, Goldhaber SZ. More than an anticoagulant: Do heparins have direct anti-inflammatory effects?
Thromb Haemost. 2017 Feb 28;117(3):437-444.
20. Alhazzani W, Lim W, Jaeschke RZ, Murad MH, Cade J, Cook DJ. Heparin thromboprophylaxis in medical-surgical
critically ill patients: a systematic review and meta-analysis of randomized trials. Crit Care Med. 2013;41(9):2088–2098.
doi:10.1097/CCM.0b013e31828cf104
21. Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, Merdji H, Clere-Jehl R, Schenck M, Fagot
Gandet F, Fafi-Kremer S, Castelain V, Schneider F, Grunebaum L, Anglés-Cano E, Sattler L, Mertes PM, Meziani F;
CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and
Research in Sepsis). High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective
cohort study. Intensive Care Med. 2020 Jun;46(6):1089-1098. doi: 10.1007/s00134-020-06062-x. Epub 2020 May 4. PMID:
32367170; PMCID: PMC7197634.
22. Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers D, Kant KM, Kaptein FHJ, van Paassen J, Stals MAM,
Huisman MV, Endeman H. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU
patients with COVID-19: An updated analysis. Thromb Res. 2020 Jul;191:148-150. doi: 10.1016/j.thromres.2020.04.041.
Epub 2020 Apr 30. PMID: 32381264; PMCID: PMC7192101.
23. Middeldorp S, Coppens M, van Haaps TF, Foppen M, Vlaar AP, Müller MCA, Bouman CCS, Beenen LFM, Kootte RS,
Heijmans J, Smits LP, Bonta PI, van Es N. Incidence of venous thromboembolism in hospitalized patients with COVID-19.
J Thromb Haemost. 2020 Aug;18(8):1995-2002. doi: 10.1111/jth.14888. Epub 2020 Jul 27. PMID: 32369666; PMCID:
PMC7497052.
24. Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, Kucher N, Studt JD, Sacco C, Bertuzzi A, Sandri
MT, Barco S; Humanitas COVID-19 Task Force. Venous and arterial thromboembolic complications in COVID-19 patients
admitted to an academic hospital in Milan, Italy. Thromb Res. 2020 Jul;191:9-14. doi: 10.1016/j.thromres.2020.04.024.
Epub 2020 Apr 23. PMID: 32353746; PMCID: PMC7177070.
25. Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R, Jabri A, Satlin MJ, Campion TR Jr, Nahid M, Ringel JB, Hoffman KL,
Alshak MN, Li HA, Wehmeyer GT, Rajan M, Reshetnyak E, Hupert N, Horn EM, Martinez FJ, Gulick RM, Safford MM.
Clinical Characteristics of Covid-19 in New York City. N Engl J Med. 2020 Jun 11;382(24):2372-2374. doi:
10.1056/NEJMc2010419. Epub 2020 Apr 17. PMID: 32302078; PMCID: PMC7182018.
26. Fraissé M, Logre E, Pajot O, Mentec H, Plantefève G, Contou D. Thrombotic and hemorrhagic events in critically ill
COVID-19 patients: a French monocenter retrospective study. Crit Care. 2020 Jun 2;24(1):275. doi: 10.1186/s13054-020-
03025-y. PMID: 32487122; PMCID: PMC7265664.
27. Nopp S, Moik F, Jilma B, Pabinger I, Ay C. Risk of venous thromboembolism in patients with COVID-19: A systematic
review and meta-analysis. Res Pract Thromb Haemost. 2020 Sep 25;4(7):1178–91. doi: 10.1002/rth2.12439. Epub ahead of
print. PMID: 33043231; PMCID: PMC7537137.
28. Patell R, Bogue T, Koshy A, Bindal P, Merrill M, Aird WC, Bauer KA, Zwicker JI. Postdischarge thrombosis and
hemorrhage in patients with COVID-19. Blood. 2020 Sep 10;136(11):1342-1346. doi: 10.1182/blood.2020007938. PMID:
32766883; PMCID: PMC7483433.
12/12/20 8 Version 9.0
Version 9.0 12.12.20
© Copyright 2020 The General Hospital Corporation. All Rights Reserved.

29. Roberts LN, Whyte MB, Georgiou L, Giron G, Czuprynska J, Rea C, Vadher B, Patel RK, Gee E, Arya R. Postdischarge
venous thromboembolism following hospital admission with COVID-19. Blood. 2020 Sep 10;136(11):1347-1350. doi:
10.1182/blood.2020008086. PMID: 32746455; PMCID: PMC7483432.
30. Hill JB, Garcia D, Crowther M, Savage B, Peress S, Chang K, Deitelzweig S. Frequency of venous thromboembolism in
6513 patients with COVID-19: a retrospective study. Blood Adv. 2020 Nov 10;4(21):5373-5377. doi:
10.1182/bloodadvances.2020003083. PMID: 33137202; PMCID: PMC7656921.
31. Rosovsky RP, Grodzin C, Channick R, Davis GA, Giri JS, Horowitz J, Kabrhel C, Lookstein R, Merli G, Morris TA,
Rivera-Lebron B, Tapson V, Todoran TM, Weinberg AS, Rosenfield K; PERT Consortium. Diagnosis and Treatment of
Pulmonary Embolism During the Coronavirus Disease 2019 Pandemic: A Position Paper From the National PERT
Consortium. Chest. 2020 Aug 27:S0012-3692(20)34287-2. doi: 10.1016/j.chest.2020.08.2064. Epub ahead of print. PMID:
32861692; PMCID: PMC7450258.
32. Zhang B, Zhou X, Qiu Y, Song Y, Feng F, Feng J, Song Q, Jia Q, Wang J. Clinical characteristics of 82 cases of death from
COVID-19. PLoS One. 2020 Jul 9;15(7):e0235458. doi: 10.1371/journal.pone.0235458. PMID: 32645044; PMCID:
PMC7347130.

12/12/20 9 Version 9.0