Letter to the Editor: Venous Thromboembolism in COVID-19: Are Women Different?

Abstract

I read with interest the article 1 about therapeutic anticoagulation in patients with coronavirus disease 2019 (COVID-19) and considerations in women. I applaud the authors for performing rigorous review to address this important clinical concern in COVID-19. High prevalence of venous thromboembolism (VTE) was observed in 22.7% of patients in intensive care units. 2 Observational studies and initial autopsy series showed high rates of both venous and arterial thrombosis as well as prominent pulmonary microvascular thrombosis. Patients with COVID-19 were reported to have 6% more risk to develop VTE as compared to non-COVID-19 patients. 3 In addition, COVID-19-associated coagulopathy was recognized as a marker of disease severity and poor prognosis. Contrasting results have been reported about the pre-ferred anticoagulation therapy in patients with COVID-19 infection. As evident in the given article, 1 the recommenda-tions by various societies and guidelines kept on changing as the evidence emerged. Elevated D-dimer levels were reported as predictive for breakthrough thrombosis 4 despite standard deep vein thrombosis prophylaxis. Some institu-tions started risk-stratifying patients for VTE based on the D-dimer cutoff points and started intermediate-dose prophy-laxis in critically ill patients with COVID-19. 5 Follow-up studies have con fi rmed signi fi cant coagulopathy associated with severe COVID-19, characterized by marked elevation of fi brinogen, von Willebrand factor, and platelet and profound endothelia