Table 9.
Anticoagulation doses and recommendations.
| Kidney function |
||
|---|---|---|
| Clinical profile of patient | CrCl > 30 mL/min | CrCl < 30 mL/min |
| DD > 2000 ng/mL, high inflammation markers, need for MV, existence of other thrombotic risk factors and/or progression to MOF *Assess clinical situation and risk of bleeding |
Intermediate doses: Enoxaparin 1 mg/kg/24 h sc Anticoagulant doses: Enoxaparin 1.5 mg/kg/24 h or 1 mg/kg/12 h sc Bemiparin 115 IU/kg/24 h sc |
Intermediate doses: Enoxaparin 0.5 mg/kg/24 h sc Anticoagulant doses: Enoxaparin 0.75 mg/kg/24 h or 0.5 mg/kg/12 h sc or 1 mg/kg/24 h sc Bemiparin 85 IU/kg/24 h sc |
| Evidence of arterial or venous thrombosis (diagnostic test) | [2.0] Enoxaparin 1 mg/kg/12 h sc Bemiparin 115 IU/kg/24 h sc UFH 10 IU/kg/h (aPTT ratio 1.5−2.5) If HIT: Fondaparinux if CrCl > 50 mL/min: < 50 kg: 5 mg/24 h sc 50−100 kg: 7.5 mg/24 h > 100 kg: 10 mg/24 h sc Argatroban: Start at 0.5 mcg/kg/min (maximum dose 10 mcg/kg/min) for an a aPTT ratio of 1.5−3. Contraindicated in severe liver failure |
[2,0] Enoxaparin 1 mg/kg/24 h sc Bemiparin 85 IU/kg/24 h sc UFH 10 IU/kg/h (aPTT ratio 1.5−2.5) If HIT: Fondaparinux: CrCl < 20 mL/min: CONTRAINDICATED CrCl 20−50 mL/min: 5 mg Argatroban: no changes |
| High clinical suspicion of thrombosis + high DD (impossible to confirm) | ||
|
Prior treatment with vitamin K antagonists or ACOD | ||
| • LMWH: monitor anti-factor-Xa levels | ||
| • Assess concomitant use of pneumatic compression measures | ||
| • Whenever possible perform diagnostic tests (vein echo-Doppler, TTE and/or TEE, CCTA) | ||
| • In the absence of drug interactions, risk of bleeding or need for invasive techniques oral anticoagulation could be initiated or maintained. When in doubt, consult possible interactions at http://covid19-druginteractions.org/ | ||
aPTT, activated partial thromboplastin time; CCTA, coronary computed tomography angiography; CrCl, creatinine clearance; DD, D-dimer; HIT, heparin-induced thrombocytopenia; LMWH, low-molecular weight heparin; MOF, multiorgan failure; MV, mechanical ventilation; sc, subcutaneous; TEE, transesophageal echocardiogram; TTE, transthoracic echocardiogram; UFH, unfractionated heparin.