Anticoagulation in COVID-19 patients

COVID-19 is a hypercoagulable state with an increased risk of thromboembolism in hospitalized individuals (typically venous but may be arterial). Bleeding is much less common but can occur, including intracerebral bleeding. All decisions about anticoagulation are individualized based on clinical criteria rather than on isolated laboratory findings. Some individuals in the ICU may reasonably use therapeutic dose anticoagulation for thromboembolism prophylaxis if their risk of thrombosis is high and bleeding is low. Some non-ICU inpatients may reasonably use prophylactic dose anticoagulation for thromboembolism prophylaxis if their risk of thrombosis is low and bleeding risk is high.

AF: atrial fibrillation; COVID-19: coronavirus disease 2019; CrCl: creatinine clearance; DVT: deep vein thrombosis; HIT: heparin-induced thrombocytopenia; ICU: intensive care unit; LMW: low molecular weight; MI: myocardial infarction; PE: pulmonary embolism; PERT: pulmonary embolism response team; RRT: renal replacement therapy; tPA: tissue plasminogen activator; VTE: venous thromboembolism.

* Appropriate testing to document suspected thromboembolism is advised if feasible. Assistance from a specialist (pulmonary, critical care, hematology) may be required. Refer to UpToDate for details of testing.

¶ Adjustment of dosing based on weight may be appropriate, as discussed in UpToDate.

Δ High-risk features include prior VTE, recent surgery or trauma, or cast immobilization.

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Anticoagulation in COVID-19 patients