Table 1.
Summary of the anticoagulant-based management strategy proposed for inpatients with COVID-19 in the paper under comment [4]. Coagulation tests are recommended in each situation, in order to evaluate the status of the coagulation system and the safety of using anticoagulation. Standard dose VTE prophylaxis should be considered in outpatients.
| Ward | ICU | VTE |
ARDS | ||
|---|---|---|---|---|---|
| Confirmed | Presumed PEb | ||||
| Anticoagulation dose | |||||
| Prophylactic | |||||
| Standard dose | X | ||||
| Intermediate dosea | X | X | |||
| Therapeutic | X | X | |||
Anticoagulant options: LMWH, UFH and fondaparinux. Direct oral anticoagulants are used in some centres, but intermediate intensity doses are not defined. Renal insufficiency is a strong modulator of the anticoagulant option.
No supporting data except in small studies and obese patients. Many centres use an escalation strategy, giving half the therapeutic dose.
Based on clinical symptoms such as change in respiratory status, right heart strain on echocardiogram, faced to the inability to obtain imaging.