Position paper on the management of antithrombotic therapy in patients with dengue

Dengue is endemic in more than 100 countries, primarily affecting tropical and subtropical regions, including Argentina. Between epidemiological weeks (EW) 1 and 47 of 2024, the Region of the Americas reported a cumulative incidence of 1,327 cases per 100,000 inhabitants, representing a 197% increase compared with 2023. By EW47, 160 cases (0.3%) were classified as severe dengue, with 45 deaths (case fatality rate [CFR]: 0.084%). In Argentina, sustained viral circulation has been documented since 2023, including during winter months, particularly in the northeastern region. During the 2024 season, the cumulative incidence reached 1,203 cases per 100,000 population, more than threefold higher than in 2022–2023. The Northwest (NOA) region reported the highest incidence (2,533 per 100,000), followed by the Northeast (NEA, 1,645) and Central region (1,098). Although incidence was lower in the Central region, it accounted for the majority of absolute cases (58.7%). Overall, 1,604 cases met severity criteria and 408 deaths were recorded (CFR: 0.07%). Thrombocytopenia was observed in 25–90% of patients, with platelet counts below 20,000/mm³ in approximately half of severe cases. This position paper, based on real-world clinical experience at the main dengue referral center in Salta Province, Argentina, addresses the management of antiplatelet and anticoagulant therapies in dengue patients with thrombocytopenia. The recommendations aim to provide guidance for clinicians managing cardiovascular comorbidities during dengue outbreaks in endemic regions. The current paper focuses on the indicated therapeutic use of antiplatelet- and anticoagulant treatment in dengue patients experiencing thrombocytopenia.