Thromboprophylaxis in COVID-19
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For patients on regular therapeutic anticoagulants who are deteriorating, consider switching to treatment-dose LMWH.
Thromboprophylaxis doses in COVID-19​
Standard-dose enoxaparin​
| Weight | CrCl > 30 | CrCl ⩽ 30 * |
|---|---|---|
| < 50 kg | 20 mg OD | 20 mg OD |
| 50 - 100 kg | 40 mg OD | 20 mg OD |
| 101 - 150 kg | 40 mg BD | 40 mg OD |
| > 150 kg | 60 mg BD | Seek renal advice |
* Including dialysis
Intermediate-dose enoxaparin​
| Weight | CrCl > 30 | CrCl ⩽ 30 * |
|---|---|---|
| < 50 kg | 40 mg OD | 20 mg OD |
| 50 - 100 kg | 40 mg BD | 40 mg OD |
| 101 - 150 kg | 60 mg BD | 60 mg OD |
| > 150 kg | 80 mg BD | Seek renal advice |
* Including dialysis
Treatment-dose LMWH​
| Weight | CrCl > 30 | CrCl 20 - 30 | CrCl < 20 |
|---|---|---|---|
| < 100 kg | Enoxaparin 1.5 mg/kg OD | Tinzaparin 175 units/kg OD | Tinzaparin 125 units/kg OD * |
| ≥ 100 kg | Enoxaparin 1 mg/kg BD | Tinzaparin 175 units/kg OD | Tinzaparin 125 units/kg OD * |
* Check anti-Xa weekly and liaise with Haemtology
Extended thromboprophylaxis on inpatient discharge​
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There is currently no evidence for routine thromboprophylaxis in patients with mild or moderate COVID-19 who are deemed suitable for discharge from ED.
Consider 14 days of prophylactic anticoagulation from the date of discharge if all of the following are present:
- COVID +ve and still unwell
- No significant bleeding risk factors
- Anticipated reduction in mobility post-discharge
- Any of:
- Active cancer or cancer treatment
- Previous VTE and not on regular anticoagulation
- BMI > 35
- ITU admission
- Age > 75
Anticoagulants for extended thromboprophylaxis in COVID-19​
1st-line: Apixaban 2.5 mg PO BD (off-label) or rivaroxaban 10 mg PO OD (off-label)
2nd-line: Standard-dose enoxaparin
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Consider enoxaparin as 1st-line if:
- Weight < 50 kg or > 140 kg
- CrCl < 15 mL/min
- Drug interactions with apixaban or rivaroxaban