Risk of thrombosis due to coronavirus – patient's own assessment

Coronavirus infection is associated with an increased risk of vascular thrombosis. You can use the questions below to assess whether you have an increased risk of vascular thrombosis. An increased risk of thrombosis may increase the development of a serious form of coronavirus disease.

You can report your thrombosis risk information in the MyCovidData service if your recent COVID-19 test was positive using an at-home test or a laboratory-confirmed test. The information is transmitted to the infection tracking system of your municipality. You can log in to the MyCovidData service at mycoviddata.fi by using your online banking credentials or mobile ID. If your risk of vascular thrombosis is elevated in the MyCovidData service or in the survey below and you are recommended to initiate heparin therapy, always phone the helpline listed on the website of your municipality.

Also check whether you belong to any of the groups eligible for treatment with the coronavirus medicine Paxlovid

1. If you are taking any of the medicines to prevent blood clotting which are listed below (trade names in brackets), you have protection against the risk of a coronavirus infection related vascular thrombosis and you can stop the survey here.

• Anticoagulants or so-called blood-thinning medication (Marevan, Eliquis, Xarelto, Lixiana, Pradaxa)
• Subcutaneous heparin therapy (Fragmin, Innohep, Inhixa, Ghemaxan, Enoxaparin Becat)

2. If you do not take medicines to prevent blood clotting which are listed above, you may be at risk of thrombosis due to coronavirus. First check your symptoms and then check for risk factors.

2. 1. Symptom or pregnancy/childbirth 

• If you have any the following symptoms: temperature higher than 37.5 °C or cough or shortness of breath, OR
• you are pregnant, OR
• you have given birth less than six weeks ago or you have had a cesarean section,

go to section 2.2.

If you meet none of the above criteria, you don't need to assess your situation any further and you can stop the survey here. There is no need for anticoagulant medication with mild infections.

2. 2. Risk factors, do you have

At least one of these risk factors (significant risk of thrombosis):

• Previously had a venous or arterial blood clot
• Thrombosis susceptibility (such as: APC resistance, FV Leiden gene defect, prothrombin gene defect G20210A, antithrombin and protein C or S deficiency, essential thrombocytosis, polycythemia vera, myeloma, PNH disease, phospholipid antibody syndrome)  
• Cancer or malignant blood disorder that is being treated.
• Multiple injury or recent spinal cord injury
• Major surgical procedure within a time period of less than one month and/or bed rest has been prescribed at the moment as a result of such a procedure

OR

At least three of these risk factors (trade names of medicines in brackets):

• age at least 60 years
• Body mass index (BMI) greater than 30 (BMI calculator in Finnish)
• you are in a wheelchair or are paralyzed
• cardiovascular disease (not including hypertension that is under good treatment control)
• lower limb venous insufficiency
• diabetes
• fatty liver
• autoimmune disease (such as Crohn’s disease, ulcerative colitis, connective tissue disease, or rheumatoid arthritis)
• severe renal disease
• you have recently undergone a surgical procedure (within six weeks), you have a limb fracture, or a closed lower limb cast 
• you are on estrogen replacement therapy (oral, not gel or patch) or you are taking combined oral contraceptive pills (does not apply to use of luteal hormone contraceptives, i.e. the minipill)
• you are taking clozapine as a psychotropic drug (Leponex, Froidir, Clozapine Accord)
• you are a smoker

OR

you are 60 years of age or older AND have been mainly on bed rest for more than three days.

3.  Instructions – How do I proceed?

If you have proceeded to risk factors listed in section 2.2. and you have at least one risk factor listed in the first group (significant risk of thrombosis) OR at least three risk factors listed in the second group OR you are 60 years of age or older and you have mainly been on bed rest for more than three days, go to your municipality’s website and see the contact information for cases requiring initiation of possible heparin therapy injections based on the thrombosis risk (coronavirus helpline or appointment to see a physician).

The Medical Helpline 116117 is not responsible for thrombosis risk assessments. Note, however, that the questions presented here are for screening purposes and you may not need anticoagulant medication despite the risk factors. It is not necessary to carry out an assessment of the need for antithrombotic medication on the same day. Before initiating any medication, also the contraindications to heparin therapy are always assessed.

4. Common thrombosis prevention measures recommended for all

• Drink enough (2–2.5 liters) fluids every day.
• Use a special stocking for venous insufficiency or so-called flight socks, if you have any.
• If you are bedridden, still try to walk regularly, change position, move your legs, and avoid taking sleeping pills.
• Make sure that you take your prescribed anticoagulant medication, and medication for blood pressure, diabetes and cholesterol according to the instructions, even if you are prescribed other medication.

Contact your healthcare provider immediately if you experience symptoms of a thrombosis such as pain in your lower limb, upper limb, or chest or shortness of breath, worsening headache, unilateral symptoms or abdominal pain (contact Medical Helpline tel. 116 117 or in emergencies tel. 112.)