Management of patients on antithrombotic therapy with severe infections: a joint clinical consensus statement of the ESC Working Group on Thrombosis, the ESC Working Group on Atherosclerosis and Vascular Biology, and the International Society on Thrombosis and Haemostasis
Individuals on single or combined antithrombotic therapy with high or very high cardiovascular risk have an elevated susceptibility to severe infections and related complications, both in the short and long term. When infection and sepsis is associated with coagulopathy, adjustments to antithrombotic therapy is often necessary based on underlying cardiovascular conditions, treatment indications, clinical status, and patient prognosis:
If the platelet count falls below 100 × 10^9/L in patients already on oral anticoagulation (OAC), heparins should be utilized; heparins should be discontinued if the platelet count drops below 30 × 10^9/L.
Individuals on dual antiplatelet therapy (DAPT) should transition to single antiplatelet therapy (SAPT) using a P2Y12 inhibitor or low-dose acetylsalicylic acid (ASA) when the platelet count is less than 30 × 10^9/L; single antiplatelet therapy with ASA might be preferable when the platelet count falls below 30 × 10^9/L.
If the platelet count decreases to below 20 × 10^9/L, antithrombotic therapy should be halted. An exception could be considered for patients with very recent acute coronary syndrome (within <3 months), in whom low-dose ASA might still be an option.