Table 1.
Early Societal Guidelines Regarding Thromboprophylaxis in COVID-19
| Guideline | Outpatient | In-Hospital Noncritically Ill | In-Hospital Critically Ill | Postdischarge |
|---|---|---|---|---|
| Global COVID-19 Thrombosis Collaborative Group6 (April 17, 2020) | In the absence of high-quality data, pharmacologic prophylaxis should be reserved for those patients at highest risk, including those with limited mobility and history of prior VTE or active malignancy | Prophylactic daily LMWH or subcutaneous UFH bid | Prophylactic daily LMWH or subcutaneous UFH bid | It is reasonable to employ individualized risk stratification for thrombotic and hemorrhagic risk, followed by consideration of extended prophylaxis (for up to 45 d) for patients with elevated risk of VTE who have low risk of bleeding |
| International Society of Thrombosis and Haemostasis10 (May 27, 2020) | NA | A universal strategy of routine thromboprophylaxis with standard dose UFH or LMWH should be used after careful assessment of bleed risk, with LMWH as the preferred agent. Intermediate dose LMWH may also be considered | Routine thromboprophylaxis with prophylactic dose UFH or LMWH should be used after careful assessment of bleed risk. Intermediate dose LMWH can also be considered in high-risk patients | Extended postdischarge thromboprophylaxis should be considered for all hospitalized patients with COVID-19 who meet high VTE risk criteria |
| Chest Guideline and Expert Panel Report3 (June 2, 2020) | NA | In hospitalized patients with acute illness with COVID-19, we recommend current standard dose anticoagulant thromboprophylaxis over intermediate or full treatment dosing, per existing guidelines | In critically ill patients with COVID-19, we suggest current standard dose anticoagulant thromboprophylaxis over intermediate or full treatment dosing, per existing guidelines | In patients with COVID-19, we recommend inpatient thromboprophylaxis only over inpatient plus extended thromboprophylaxis after hospital discharge |
| VAS-European Independent Foundation in Angiology/Vascular Medicine8 (September 13, 2020) | NA | Routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication) | Routine thromboprophylaxis with weight-adjusted intermediate doses of LMWH (unless contraindication) | Evaluation of the risk of VTE before hospital discharge using the IMPROVE-D-dimer score and prolonged postdischarge thromboprophylaxis with rivaroxaban, betrixaban, or LMWH |
| World Health Organization5 (January 25, 2021) | NA | In hospitalized patients with COVID-19, without an established indication for higher dose anticoagulation, we suggest administering standard thromboprophylaxis dosing of anticoagulation rather than therapeutic or intermediate dosing | In hospitalized patients with COVID-19, without an established indication for higher dose anticoagulation, we suggest administering standard thromboprophylaxis dosing of anticoagulation rather than therapeutic or intermediate dosing | NA |
| American Society of Hematology7 (February 8, 2021) | NA | Prophylactic-intensity over intermediate-intensity or therapeutic-intensity anticoagulation for patients with COVID-19-related acute illness who do not have suspected or confirmed VTE | Prophylactic-intensity over intermediate-intensity or therapeutic-intensity anticoagulation for patients with COVID-19-related critical illness who do not have suspected or confirmed VTE | NA |
| National Institutes of Health9 (February 11, 2021) | For nonhospitalized patients with COVID-19, anticoagulants and antiplatelet therapy should not be initiated for the prevention of VTE or arterial thrombosis unless the patient has other indications for the therapy or is participating in a clinical trial | Hospitalized nonpregnant adults with COVID-19 should receive prophylactic dose anticoagulation | Hospitalized nonpregnant adults with COVID-19 should receive prophylactic dose anticoagulation | Hospitalized patients with COVID-19 should not routinely be discharged from the hospital while on VTE prophylaxis. Continuing anticoagulation with a US Food and Drug Administration-approved regimen for extended VTE prophylaxis after hospital discharge can be considered for patients who are at low risk for bleeding and high risk for VTE |
| National Institute for Health and Care Excellence4 (March 6, 2021) | Consider pharmacologic prophylaxis if the risk of VTE outweighs the risk of bleeding | Consider a treatment dose of an LMWH, unless contraindicated, for young people and adults with COVID-19 who: (1) are likely to be in the hospital for the next 3 d; (2) need supplemental oxygen and who are not yet receiving high-flow oxygen, CPAP, noninvasive ventilation, or invasive mechanical ventilation | For young people and adults who are already receiving high-flow oxygen, CPAP, noninvasive ventilation, or invasive mechanical ventilation and are on a standard prophylactic dose of an LMWH for VTE prophylaxis: (1) consider increasing anticoagulation to an intermediate dose; (2) reassess VTE and bleeding risks daily | Treatment should be for a minimum of 14 d or until discharge |
LMWH = low-molecular-weight heparin; NA = not available; UFH = unfractionated heparin; VAS = Angiology Vascular Medicine.