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. 2023 Jun 30;16(9):1510–1525. doi: 10.1111/cts.13569

TABLE 3.

Clinical recommendations for the use of anticoagulants in special populations infected with COVID‐19.

Special population Recommendations and dosage Study or guideline (year)
Obesity (BMI ≥30 kg/m2) or morbid obesity (BMI ≥40 kg/m2) When hospitalized, intermediate‐dose or weight‐adjusted LMWH as a thromboprophylaxis regimen should be considered. Spyropoulos et al. (2020) 92
Renal impairment When CrCl <30 mL/min or acute kidney injury occurred, 5000 units of UFH subcutaneously two or three times a day or low‐dose LMWH should be considered. OBE et al. (2020) 93
Pregnant women
Antepartum evaluation
  • Non‐hospitalized
    1. Hydration and activity.
    2. Prophylactic LMWH should be continued for 7–14 days after recovery if the VTE risk score is >3.
  • Hospitalized
    1. When admitted, thromboprophylaxis must be initiated unless it is contraindicated or a pregnancy is anticipated within 24 h.
    2. When on high‐flow oxygen, CPAP, non‐invasive/invasive ventilation, a thromboprophylaxis dose of LMWH should be initiated.
Postpartum evaluation
  1. After birth, evaluate the risk of VTE.
  2. For those who have a confirmed COVID‐19 infection, LMWH prophylaxis for 10 days is advised.
 RCOG (2022) 94
Antepartum evaluation
  1. If there are no contraindications, continuation of anticoagulant or antiplatelet medication for underlying disorders should be considered.
  2. When admitted with confirmed COVID‐19, initiation of prophylactic‐dose anticoagulation should be considered.
  3. Pregnant individuals are not often advised to get post‐discharge thromboprophylaxis; instead, specific recommendations are made based on coexisting VTE risk factors.
Postpartum evaluation
  1. Those who need VTE prevention or treatment should get anticoagulant medication.
 NIH (2022) 95
Pediatrics When hospitalized with significantly increased D‐dimer or superimposed clinical risk factors for hospital‐related VTE, initiation of low‐dose LMWH subcutaneously twice a day should be considered. Goldenberg et al. (2020) 96

Abbreviations: BMI, body mass index; COVID‐19, coronavirus disease 2019; CPAP, continuous positive airway pressure; CrCl, creatinine clearance; LMWH, low‐molecular‐weight heparin; NIH, National Institute of Health; RCOG, Royal College of Obstetricians and Gynecologists; UFH, unfractionated heparin; VTE, venous thromboembolism.