Suggested approach to COVID-19 patients and coagulopathy. All admitted patients should have baseline PT, aPTT, fibrinogen, D-dimer, and platelet count. Following these values can give important information regarding status of the coagulation system and safety of using anticoagulation.

PPX, prophylaxis; Therap., therapeutic.

There are no data to support the use of an increased anticoagulant dose for prophylaxis, except in small studies in obese patients. Given the increased rates of VTE reported in COVID-19–infected ICU patients, many centers are using increased doses such as one-half the therapeutic dose for these patients. Anticoagulant options include LMWH, UFH, and fondaparinux. Direct oral anticoagulants (DOACs) can also be considered, but intermediate-intensity doses are not clear. Both fondaparinux and DOACs should be used with caution in patients with renal insufficiency due to their longer half-lives.

Consideration for use of standard-dose VTE prophylaxis in infected patients with morbid obesity or past history of VTE. Although routine use in outpatients is not recommended, use in immobile infected outpatients, especially with other increased risks for VTE, can be considered on a case-by-case basis based on severity of illness or as incorporated into local practice.

Presumed PE is based on clinical findings of change in respiratory status, evidence of right-heart strain on echocardiogram, and the inability to obtain imaging.