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:

  1. 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.
  2. 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.
  3. 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.
  4. Therapeutic-dose heparin for patients who do not require ICU care should continue for 14 days or until hospital discharge, whichever comes first.
  5. The Panel recommended against the use of therapeutic-dose direct-acting oral anticoagulants for hospitalized patients except in the setting of clinical trials.
  6. In patients who do not require ICU care but cannot receive therapeutically dosed heparin, prophylactic-dose heparin is recommended unless a contraindication exists.
  7. 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).
  8. 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.
  9. The Panel recommends prophylactic-dose heparin for pregnant patients because data are lacking on the use of therapeutic-dose heparin.
  10. 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.
  11. Some clinical trials used intermediate-dose heparin for prophylaxis doses in morbidly obese patients.

Clinical Topics: Anticoagulation Management, 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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