The emergence of COVID-19 has posed major challenges for healthcare professionals, particularly in the areas of rapid diagnosis and the provision of medical care to affected patients. Intensive research continues on the clinical and epidemiological features of the disease, as well as on the development of new methods for its prevention and treatment. COVID-19 causes a state of temporary acquired thrombophilia — an increased tendency of the body to form blood clots due to systemic inflammation and the direct effect of the virus on blood vessels.
The most common clinical manifestation of the novel coronavirus infection is bilateral pneumonia (viral diffuse alveolar damage with microangiopathy), while 3–4% of patients develop acute respiratory distress syndrome (ARDS). Some patients develop hypercoagulable syndrome with thrombosis and thromboembolism; other organs and systems may also be affected, including the central nervous system, myocardium, kidneys, liver, gastrointestinal tract, and the endocrine and immune systems. Sepsis and septic shock may also occur [1].

According to the American Society of Hematology (ASH), there is currently no conclusive evidence regarding the comparative efficacy of different types of anticoagulants. The choice of a particular drug may depend on availability, ease of use, patient contraindications, and other factors. As noted by the authors of the interim analyses of three clinical trials of anticoagulants in COVID-19 (REMAP-CAP, ACTIV-4, and ATTACC), therapeutic doses of anticoagulants did not demonstrate benefit in critically ill COVID-19 patients but improved outcomes in those with moderate disease severity [3].

The use of low-molecular-weight heparin (LMWH) therapy has been shown to reduce mortality among hospitalized patients with severe COVID-19, likely due to its anti-inflammatory and antiviral properties [5]. No single LMWH has demonstrated superiority over others. In cases where venous thromboembolic complications are suspected, therapeutic-dose anticoagulant therapy may be initiated before diagnosis is confirmed. During hospitalization, LMWH—particularly enoxaparin sodium or unfractionated heparin (UFH)—is preferred, whereas after discharge, switching to a direct oral anticoagulant (DOAC), specifically rivaroxaban, is recommended for a minimum of three months [1].

Thus, the use of either anticoagulant did not significantly alter the risks of thrombosis, bleeding, ARDS, or in-hospital mortality among COVID-19 patients.

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