Venous thromboembolism and heparin use in COVID-19 patients: juggling between pragmatic choices, suggestions of medical societies

The disease caused by coronavirus SARS-CoV-2, named COVID-19, has become a global emergency. The virus spreads via respiratory droplets and is mainly responsible for infections of the respiratory airways, with potentially fatal pneumonia. Although mortality is higher in elderly frail patients presenting with comorbidities, cases of deaths have been reported also in younger age groups. Physicians treating patients with COVID-19 are facing novel and unexpected challenges. One of these is the proper prevention and diagnosis of venous thromboembolism (VTE) and, more generally, how to deal with coagulative activation apparently existing in these patients. In this article, we discuss the many doubts currently existing on the use of heparins and the correct prevention and diagnosis of VTE in COVID-19 patients, with physicians that juggle between pragmatic choices, different suggestions being released on a daily by hospital and medical societies, and the lack of solid evidence or guidelines. Finally, we highlight the need for a call to action by the medical and scientific community.