Anticoagulation in COVID-19 at BMC

Low Risk Standard Intensity Enoxaparin Prophylaxis

• No VTE or other indication for CrCL ≥ 30mL/min • 40 mg once daily for BMI ≤40 and weight <120kg
Consider trending D-
anticoagulation • 40 mg twice daily for BMI >40 or weight >120kg
dimer and repeat risk
• D-dimer < 2,000 ng/mL stratification daily
• Milder disease severity Unfractionated SQ Heparin Prophylaxis
• Acceptable bleeding risk with no bleeding or
CrCL < 30mL/min • 5,000 units twice daily for BMI ≤40 and weight <120kg
profound thrombocytopenia (with platelets • 7,500 units twice daily for BMI >40 or weight >120kg
below 25K) or severe coagulopathy
ICU patients at
Intermediate Risk## intermediate risk:
Increased Intensity Enoxaparin Prophylaxis Consider screen for
• Very high D-dimer ≥ 2,000 • 0.5 mg/kg twice daily (with maximum dose of 70 mg
ng/mL (≥ 8x ULN of BMC assay) CrCL ≥ 30mL/min DVT with POCUS
twice daily for >130 kg)
• Moderate to severe disease
severity (i.e. PaO2/FiO2 ≤300, Pregnancy: Refer to
Unfractionated Heparin Infusion BMC’s OB VTE Guideline:
SIC score ≥4, higher SOFA score) CrCL < 30mL/min (No Bolus and Low aPTT Goal 45-65)
• Risk of bleeding deemed to be acceptable for plus may consider 3-6
more intense prophylactic anticoagulation
• No bolus with infusion of 8 units/kg/hr weeks of prophylactic
• Thrombosis risk likely persists beyond lab enoxaparin for symptomatic
findings falling below threshold
COVID postpartum patients

High Risk/Full AC Full Anticoagulation with Enoxaparin

CrCL ≥ 30mL/min • 1 mg/kg twice daily
• Confirmed VTE Consider VTE
• Established reason for screening in patients
Unfractionated Heparin Infusion with rapid increases
therapeutic AC (Afib, prosthetic
(Bolus and Standard aPTT Goal 55-90)
valve, etc.)** in D-dimer (≥ 5-fold
• If not on anticoagulation, 80 units/kg bolus
• HD/CVVHD with clotting of then infusion of 18 units/kg/hr for BMI <30 or
in 48 hours) or
dialysis tubing or lines resulting 15 units/kg/hr for BMI >30 acutely worsening
CrCL< 30mL/min oxygenation/
in repeated interruptions • If transitioning anticoagulation regimens/risk
• High clinical concern for DVT/PE category consider consulting pharmacy (page increased dead space.
but unstable/ otherwise unable 9825 off hours) for adjustment dosing Consider empiric
to undergo confirmatory testing • Consider anti-Xa level if poor response to anti-coagulation if
treatment or additional thrombosis suspected low bleeding risk
** May continue prior anticoagulation regimen if clinically deemed appropriate
## May consider extended prophylaxis for 4 wks upon discharge (potential agent such as apixaban 2.5 mg BID) based upon clinical features