Table 2. Guidelines and recommendations for thromboprophylaxis in COVID-19 patients.
| Organization/scientific society | COVID-19 patients | Recommendations of thromboprophylaxis | ||
|---|---|---|---|---|
| World Health Organization (WHO) (75) | Severe, acute respiratory infection | LMWH (preferably); unfractionated heparin 5,000 UI/12 h; intermittent pneumatic compression if pharmacological anticoagulation is contraindicated | ||
| International Society on Thrombosis and Haemostasia (ISTH) (74) | Out-patient mild disease | Encouragement of greater mobility; individualized stratification of the thrombotic and hemorrhagic risk | ||
| Hospitalized moderate or severe disease with no DIC | Individualized stratification of the thrombotic and hemorrhagic risk; prophylactic doses of LMWH (preferably) or UFH; mechanical thromboprophylaxis (intermittent pneumatic compression) if pharmacological anticoagulation is contraindicated; therapeutic anticoagulation or intermediate doses not recommended in the absence of confirmed VTE | |||
| Hospitalized moderate or severe disease with DIC | Every patient must receive prophylactic anticoagulation unless there are contraindications (active bleeding and platelet count <25×109/L); therapeutic anticoagulation or intermediate doses not recommended in the absence of confirmed VTE; pharmacological thromboprophylaxis considered at discharge for up to 45 days | |||
| American Sociedad Americana de Hematología (ASH) (76) | Hospitalized | All patients must receive pharmacological thromboprophylaxis with LMWH or Fondaparinux (preferable to UFH to reduce contact), unless there is a major risk of hemorrhage; fondaparinux in cases of heparin-induced thrombocytopenia; mechanical thromboprophylaxis if pharmacological anticoagulation is contraindicated; anticoagulation at therapeutic doses not recommended in the absence of confirmed VTE | ||
| Sociedad Española de Hemostasia y Trombosis (SETH) (79) | Infection without major risk factors for thrombosis | LMWH with adjustment of dose to weight and kidney function | ||
| Creatinine clearance >30mL/min | Creatinine clearance <30 mL/min | |||
| Enoxaparin | <80 kg: 40 mg/24 h; 80–100 kg: 60 mg/24 h; >100 kg: 40 mg/12 h | <80 kg: 20 mg/24 h; >80 kg: 40 mg/24 h | ||
| Tinzaparin | <60 kg: 3,500 UI/24 h; >60 kg: 4,500 UI/24 h | <60 kg: 3,500 UI/24 h; >60 kg: 4,500 UI/24 h | ||
| Bemiparin | 3500 UI/24 h | 2,500 UI/24 h | ||
| Nadroparin | 0.3 mL/24 h | – | ||
| Dalteparin | 5,000 UI/24 h | – | ||
| Fondaparinux if there is allergy to heparin or heparin-induced thrombocytopenia | ||||
| Creatinine clearance >50 mL/min | 2.5 mg/24 h | |||
| Creatinine clearance <50 and >20 mL/min | 2.5 mg/24 h | |||
| Creatinine clearance <20 mL/min | Contraindicated | |||
| Infection with major risk factors for thrombosis | LMWH with adjustment of dose to kidney function | |||
| Creatinine clearance >30 mL/min | Creatinine clearance <30 mL/min | |||
| Enoxaparin | 1 mg/kg/24 h | 0.5 mg/kg/24 h | ||
| Tinzaparin | 75 UI/kg/24 h | 75 UI/kg/24 h | ||
| Bemiparin | 5,000 UI/24 h | 3,500 UI/24 h | ||
| Nadroparin | <70 kg: 0.4 mL/24 h; >70 kg: 0.6 mL/24 h | – | ||
| Dalteparin | 5,000 UI/24 h | – | ||
| Fondaparinux if there is allergy to heparin or heparin-induced thrombocytopenia: | ||||
| Creatinine clearance >50 mL/min | 5 mg/24 h | |||
| Creatinine clearance <50 and >20 mL/min | 2.5 mg/24 h | |||
| Creatinine clearance <20 mL/min | Contraindicated | |||
| Thrombosis UK (77) | Hospitalized | Evaluation of thrombotic risk in all the patients (NICE/ ASH). LMWH, unless contraindicated, if there is immobilization and criteria of severity: Creatinine clearance >30: LMWH or Fondaparinux s.c. Creatinine clearance <30: UFH 5000 UI s.c. or low dose of LMWH. All patients with complete immobilization are recommended intermittent pneumatic compression, as well as pharmacological thromboprophylaxis. Mechanical thromboprophylaxis exclusively if platelets <30,000 or bleeding | ||
| Working Group on Cardiovascular Thrombosis of the Sociedad Española de Cardiología (77) | Hospitalized | All hospitalized patients must receive LMWH; adjustment of the dose is recommended inBMI>35 and after evaluating the hemorrhagic risk and the platelet count. In patients with criteria of severity and high thrombotic risk, LMWH is recommended at intermediate/extended or therapeutic doses, following an evaluation of the hemorrhagic risk. Prolongation of LMWH at prophylactic doses for 7–10 days after the hospital discharge | ||
| British Thorax Society (BTS) (80) | Low risk | Weight-adjusted prophylactic dose (e.g., 70 kg with creatinine clearance >30 mL/min: Dalteparin 5,000 UI/day, enoxaparin 40 mg/day) | ||
| High risk | LMWH at intermediate doses (e.g., 70 kg with creatinine clearance >30 mL/min: Dalteparin 5,000 UI/12h, enoxaparin 40 mg/12h) | |||
COVID-19, coronavirus disease 2019; BMI, body mass index; DIC, disseminated intravascular coagulation; LMWH, low molecular weight heparin; NICE, National Institute for Health and Care Excellence; UFH, unfractionated heparin; VTE, venous thromboembolism.