Clinicians are scrambling to optimize venous thromboembolism (VTE) prophylaxis for hospitalized patients with COVID-19.
Data suggest these patients have a higher VTE risk than other hospitalized patients. Plus D-dimer and other markers are often elevated in COVID-19...especially in severe cases.
But there's little evidence about optimal VTE prophylaxis in patients with COVID-19. Rely on a practical approach.
Ensure ALL hospitalized patients with COVID-19 receive VTE prophylaxis. Generally choose once-daily enoxaparin over BID or TID subcutaneous heparin...to reduce nursing exposure to COVID-19 patients.
Some experts step up doses when using VTE prophylaxis for select COVID-19 cases...such as an ICU patient with worsening clinical status and a D-dimer greater than 6 times the upper limit of normal.
The thinking is that thrombosis may be more common than bleeding in COVID-19-associated coagulopathy.
But weigh individual clot and bleeding risks...there's not good evidence for the ideal prevention strategy in these patients.
If possible, enroll patients in a clinical trial to capture safety and efficacy data for higher-dosing strategies.
Don't routinely continue VTE prophylaxis AFTER discharge for COVID-19 patients. There's not a clear benefit over bleeding risks in MEDICAL patients. But there aren't COVID-19-specific data.
Ensure safety parameters are in place if extended-duration prophylaxis is considered in specific situations.
For example, some specialists may use it in a COVID-19 patient at low bleeding risk...with multiple VTE risks (elevated D-dimer, etc)...who is discharged early in their recovery due to hospital space.
Verify that the VTE prophylaxis indication, duration, and follow-up are well documented in the discharge plan.
Use our chart, COVID-19 and Thromboembolism: FAQs, to find more answers about treatment and prophylaxis.
- Chest Published online Jun 2, 2020; doi:10.1016/j.chest.2020.05.559
- J Am Coll Cardiol 2020;75(23):2950-73
- J Thromb Haemost Published online May 27, 2020; doi:10.1111/jth.14929
- J Thromb Thrombolysis 2020;50(1):72-81