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Harry Spoelstra: Why Prophylactic Anticoagulation Matters in COVID-19-Related Thrombosis
Harry Spoelstra/X
Sep 26, 2025, 06:00

Harry Spoelstra: Why Prophylactic Anticoagulation Matters in COVID-19-Related Thrombosis

Harry Spoelstra, CardioVascular Surgeon, shared a post on X:

“Incidence of Deep Vein Thrombosis in Patients With COVID-19: A Systematic Review.

A potential devastating C19 complication that has had far too little attention!

Nice review article, highlighting the potential significant mortality risk of DVT/PE( Pulmonary embolism). We would like to add that even older, sometimes even “silent”, or limited DVTs increase recurrence risk, particularly during infectious periods, with COVID-19 recently taking the lead.

“There is a clear pathophysiological connection between COVID-19 and deep vein thrombosis (DVT).”

“Virchow’s Triad describes the components involved in the pathophysiology of DVT:

  • hypercoagulability,
  • venous stasis(immobility), and
  • endothelial dysfunction.

COVID-19 poses a risk for DVT because it generates all of these conditions”, but

  • Inflammation
  • Comorbidities, and
  • Hypoxia

All these factors, often combined, create a prothrombotic state, significantly elevating DVT risk in COVID-19 patients.

“DVT has been shown to have an incidence from 3% to 4.8% (as the lowest documented) and up to 47.5% (as the highest percentage seen in the studies) in patients with COVID-19.”

“Most of the 15 studies reviewed in this systematic review suggested that there is a strong association between COVID-19 and DVT.”

“Patients with elevated D-dimer were the highest predictor correlated to DVT in the context of COVID-19 due to the hypercoagulability and inflammatory state that this represents.”

“The mortality surrounding DVT in COVID-19 patients is the main reason why studies should raise awareness on the importance of thromboprophylaxis and in determining the further relationship between DVT and COVID-19.”

So, COVID-19 increases DVT/PE risk due to inflammation/ endothelial dysfunction with immobility adding to the risk, especially in hospitalized patients. Prior DVT also raises recurrence risk, even in asymptomatic/mild cases. Prophylactic anticoagulation needs your attention/consideration. A post-phlebothrombosis leg for instance carries a high future quality of life loss, but more importantly, a DVT can cause a sudden PE/Death! Therefore, IMHO that all C19 cases need D-dimer screening and subsequent thrombosis prophylaxis(= my policy!)”

Title: Incidence of Deep Vein Thrombosis in Patients With COVID-19: A Systematic Review

Authors: Secades Daniela; Dufner Krieger Sebastián; Hidalgo Ramos Roberto A; Hong, Isaac; Ortiz, Marcelo; Mac Courtney Christopher

Harry Spoelstra: Why Prophylactic Anticoagulation Matters in COVID-19-Related Thrombosis

Stay updated on all scientific advances in the field of thrombosis with Hemostasis Today.

Anticoagulation Covid-19 deep vein thrombosis Dufner Krieger Sebastián DVT DVT/PE Harry Spoelstra Health Hematology Hemostasis Hemostasis Today Hidalgo Ramos Roberto A Hong Isaac Hypercoagulability Inflammatory State Mac Courtney Christopher Medicine Ortiz Marcelo Secades Daniela thrombosis
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