Dear editor,rnA new infectious disease outbreak, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is now spreading all around the world.[1] One of the most critical understandings of the current pandemic of the coronavirus disease 2019 (COVID-19) focuses on an imbalanced coagulation status. Based on the current evidence, we can divide the COVID-19-related hypercoagulable state into two categories[2]: patients without other pre-existing indications for anticoagulant therapy who develop a state of hypercoagulability linked to SARS-CoV-2 infection especially during the cytokine storm phase, and patients already on anticoagulation in whom we have to reevaluate their drug choices, dosages, and pharmacokinetics. At the same time, recent literature recommends the use of heparin in severe SARS-CoV-2 infection, both as thromboembolic prophylaxis and as an anticoagulant therapy, in light of possible anti-inflammatory and antiviral mechanisms and less pharmacological interferences.[3] This indication should be adopted in all patients except for those with prosthetic heart valves, in whom vitamin K antagonists continue to remain the drug of choice.[4] In this subgroup of patients, strict monitoring of PT-INR is required to maintain the therapeutic range. The purpose of this article is to underline the need for good quality evidence regarding the management of this high-risk category of the patient population.