| The Surgical Technologist | JULY 2022 304 FIGURE 1 | COVID-19 patient surgical fitness flow chart. The surgeon assesses the acuity of the procedure using the specialty-specific Elective Surgery Acuity Scale (ESAS). If the procedure is of low/intermediate acuity and can be delayed, the length of delay may follow American Society of Anesthesiologists’ recommendations. After the delay, timing of surgery is a function of both the necessity of surgery and the degree of recovery of respiratory and hemostatic derangement post-COVID-19. Post-operatively, due to a high degree of hypercoagulability in many convalescent COVID-19 patients, standard pharmacologic VTE prophylaxis may be considered in all these patients. Created using BioRender.com. *Cardiorespiratory symptoms such as shortness of breath, chest pain, and fatigue are common in patients with convalescent COVID-19 (12, 13, 18, 19). Coagulopathy, including both hyper and hypocoagulable states, should be assessed pre- and post-operatively using fibrinogen levels, platelet count, and viscoelastic hemostatic assays (e.g., thromboelastography (TEG) and rotational thromboelastometry (ROTEM)). The definition of hyper and hypocoagulability are a function of institutional preference. **This is not an exhaustive list of anticoagulant agents, nor a comprehensive dosing regimen. For inpatients acutely ill with COVID-19, those with VTE, those who undergo emergent surgery, or those at risk for hemorrhage, personalized titration of anticoagulation with adjunctive viscoelastic hemostatic assays is recommended (17, 20–23). VTE prophylaxis for postoperative patients with acute or convalescent COVID-19 is not specifically addressed in recent expert consensus statements or society recommendations (24–26). As such, this recommendation is the opinion of the authors and should be judiciously applied taking into account each individual patient’s risk and benefit to anticoagulant therapy. Bunch et al. COVID-19 Immuno-Thrombosis and Surgery Frontiers in Surgery | www.frontiersin.org 4 2022 | Volume 9 | Article 889999
RkJQdWJsaXNoZXIy MTExMDc1