Anticoagulation in Hospitalized Patients With COVID-19
- Authors:
- NIH COVID-19 Treatment Panel.
- Citation:
- The COVID-19 Treatment Guidelines Panel’s Statement on Anticoagulation in Hospitalized Patients With COVID-19. Last updated January 5, 2022.
Based on new clinical trial data, the National Institutes of Health (NIH) COVID-19 Treatment Panel recommends anticoagulation regimens to prevent pulmonary embolism and deep vein thrombosis in hospitalized patients with COVID-19. The following are key points to remember from the Panel's Statement on Anticoagulation in Hospitalized Patients With COVID-19:
- Therapeutic-dose heparin should be used for patients who do not require intensive care unit (ICU) care but require low-flow oxygen, have elevated D-dimer (above the normal range), and do not have increased bleeding risk.
- For patients who do not require ICU care, low molecular weight heparin is preferred over unfractionated heparin due to lower need for a provider to perform dosing changes.
- Contraindications to therapeutic anticoagulation for patients with COVID-19 are platelet count <50,000 cells/L, hemoglobin <8 g/dL, need for dual antiplatelet therapy, and known bleeding within the past 30 days that required intervention in the emergency room or hospitalization.
- Therapeutic-dose heparin for patients who do not require ICU care should continue for 14 days or until hospital discharge, whichever comes first.
- The Panel recommended against the use of therapeutic-dose direct-acting oral anticoagulants for hospitalized patients except in the setting of clinical trials.
- In patients who do not require ICU care but cannot receive therapeutically dosed heparin, prophylactic-dose heparin is recommended unless a contraindication exists.
- Prophylactic-dose heparin is recommended for hospitalized nonpregnant patients who are receiving ICU level of care, which includes patients receiving high-flow oxygen (unless a contraindication exists).
- For patients who start on therapeutic-dose heparin while on low-flow oxygen who then transfer to the ICU, the Panel recommends switching to prophylactic-dose heparin.
- The Panel recommends prophylactic-dose heparin for pregnant patients because data are lacking on the use of therapeutic-dose heparin.
- The Panel recommends using intermediate-dose heparin (e.g., enoxaparin 1 mg/kg subcutaneously daily for a patient with creatinine clearance ≥30 mL/min) unless in the setting of a clinical trial.
- Some clinical trials used intermediate-dose heparin for prophylaxis doses in morbidly obese patients.
Clinical Topics: Anticoagulation Management, COVID-19 Hub, Prevention, Vascular Medicine
Keywords: Anticoagulants, COVID-19, Creatinine, Enoxaparin, Factor Xa Inhibitors, Hemoglobins, Heparin, Heparin, Low-Molecular-Weight, Intensive Care Units, Obesity, Morbid, Oxygen, Patient Discharge, Platelet Aggregation Inhibitors, Pregnancy, Primary Prevention, Pulmonary Embolism, Vascular Diseases
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