Anticoagulation guidelines for anticoagulation in hospitalized patients with COVID-19
| . | Hospitalized noncritically ill patients . | Critically ill patients . | Postdischarge prophylaxis . |
|---|---|---|---|
| ASH32 | Suggest therapeutic-intensity over prophylactic-intensity anticoagulation (conditional recommendation, very low certainty) | Suggest prophylactic-intensity over intermediate-intensity anticoagulation (conditional recommendation, low certainty) | Suggests not using postdischarge prophylaxis (conditional recommendation, very low certainty) |
| CHEST29,33 | Suggest therapeutic dose heparin over standard dose anticoagulant thromboprophylaxis (conditional recommendation, ungraded consensus-based statement) | Suggest standard dose anticoagulant thromboprophylaxis over intermediate or therapeutic dose anticoagulation (conditional recommendation, ungraded consensus-based statement) | Recommend inpatient only over inpatient plus postdischarge prophylaxis |
| ISTH34 | Recommend therapeutic anticoagulation in select patients (I, A) | Intermediate or therapeutic dose anticoagulation not recommended over prophylactic-dose heparin (3, B-R) | In select patients, postdischarge prophylactic dose rivaroxaban may be considered (2b, B-R) |
| NICE31 | Consider treatment dose LMWH for young people and adults with COVID-19 who need low-flow oxygen and who do not have an increased bleeding risk (conditional recommendation) | Intermediate or treatment dose heparin offered only as part of a clinical trial (only in research settings) | In-hospital prophylaxis should continue for 7 d, including after discharge (recommendation) |
| NIH COVID-19 Guideline42 | Recommend therapeutic-dose heparin for patients who have a D-dimer above the upper limit of normal, require low-flow oxygen, and have no increased bleeding risk (CIIa) | Recommend prophylactic-dose heparin (AI). Recommends against the use of intermediate-dose (eg, enoxaparin 1 mg/kg daily) and therapeutic-dose anticoagulation for VTE prophylaxis, except in a clinical trial (BI) | Recommends against routinely continuing VTE prophylaxis after hospital discharge (AIII). For patients who are at high risk for VTE and at low risk of bleeding, extended VTE prophylaxis can be considered, as per the protocol for patients without COVID-19 (BI) |
| World Health Organization30 | Suggest standard thromboprophylaxis dosing* (conditional recommendation, very low certainty) | Suggest standard thromboprophylaxis dosing* (conditional recommendation, very low certainty) |
| . | Hospitalized noncritically ill patients . | Critically ill patients . | Postdischarge prophylaxis . |
|---|---|---|---|
| ASH32 | Suggest therapeutic-intensity over prophylactic-intensity anticoagulation (conditional recommendation, very low certainty) | Suggest prophylactic-intensity over intermediate-intensity anticoagulation (conditional recommendation, low certainty) | Suggests not using postdischarge prophylaxis (conditional recommendation, very low certainty) |
| CHEST29,33 | Suggest therapeutic dose heparin over standard dose anticoagulant thromboprophylaxis (conditional recommendation, ungraded consensus-based statement) | Suggest standard dose anticoagulant thromboprophylaxis over intermediate or therapeutic dose anticoagulation (conditional recommendation, ungraded consensus-based statement) | Recommend inpatient only over inpatient plus postdischarge prophylaxis |
| ISTH34 | Recommend therapeutic anticoagulation in select patients (I, A) | Intermediate or therapeutic dose anticoagulation not recommended over prophylactic-dose heparin (3, B-R) | In select patients, postdischarge prophylactic dose rivaroxaban may be considered (2b, B-R) |
| NICE31 | Consider treatment dose LMWH for young people and adults with COVID-19 who need low-flow oxygen and who do not have an increased bleeding risk (conditional recommendation) | Intermediate or treatment dose heparin offered only as part of a clinical trial (only in research settings) | In-hospital prophylaxis should continue for 7 d, including after discharge (recommendation) |
| NIH COVID-19 Guideline42 | Recommend therapeutic-dose heparin for patients who have a D-dimer above the upper limit of normal, require low-flow oxygen, and have no increased bleeding risk (CIIa) | Recommend prophylactic-dose heparin (AI). Recommends against the use of intermediate-dose (eg, enoxaparin 1 mg/kg daily) and therapeutic-dose anticoagulation for VTE prophylaxis, except in a clinical trial (BI) | Recommends against routinely continuing VTE prophylaxis after hospital discharge (AIII). For patients who are at high risk for VTE and at low risk of bleeding, extended VTE prophylaxis can be considered, as per the protocol for patients without COVID-19 (BI) |
| World Health Organization30 | Suggest standard thromboprophylaxis dosing* (conditional recommendation, very low certainty) | Suggest standard thromboprophylaxis dosing* (conditional recommendation, very low certainty) |
ISTH guideline used American Heart Association recommendations and levels of evidence: 1, strong; 2b, weak; 3, no benefit; A, high quality evidence; B-R, moderate quality evidence. NIH COVID-19 guideline strength of recommendation: A, strong recommendation for the statement; B, moderate recommendation for the statement; C, optional recommendation for the statement. Quality of evidence for recommendation: I, 1 or more randomized trials without major limitations; IIa, other randomized trials or subgroup analyses of randomized trials; IIb, nonrandomized trials or observational cohort studies; III, expert opinion.
Recommendation made before completion of randomized control trials.