Prophylactic vs Therapeutic dose anticoagulation – Recomm

We recommend at least prophylactic dose of anti-coagulation in all hospitalised patients with COVID-19 (Strong recommendation).

A strong recommendation is one for which the panel is confident about the desirable effects over undesirable effects of the intervention, or other aspects, such as cost and feasibility.

The panel recommends a dose of LMWH 40 mg OD to LMWH 1 mg/Kg/OD SC, or Unfractionated Heparin 5000 U Q12H SC.

Definition of mild:

•  Symptomatic (any acute COVID-19 related symptoms)
•  AND respiratory rate <24/min
•  WITHOUT pneumonia or hypoxia

We recommend use of therapeutic anticoagulation in hospitalized patients with progressively increasing oxygen requirements in moderate to severe COVID-19 illness (Strong recommendation).

A strong recommendation is one for which the panel is confident about the desirable effects over undesirable effects of the intervention, or other aspects, such as cost and feasibility.

The panel recommends a dose of LMWH 1 mg/Kg/BD SC.

Definition of moderate illness:

•  Pneumonia (clinical or radiological) OR hypoxia (SpO2 <94% in adults with no underlying lung disease)
•  AND respiratory rate ≤30/min
•  AND SpO2 ≥90% on room air

Definition of Severe illness

Pneumonia with ANY ONE of the following:

•  severe respiratory distress or respiratory rate >30/min
•  SpO2 <90% on room air
•  NO invasive or non-invasive respiratory support needed

We recommend use of therapeutic anticoagulation in hospitalized patients requiring organ support in critical COVID-19 illness (Conditional recommendation).

A conditional recommendation is one for which the panel is less confident about the balance between desirable and undesirable effects of the intervention, or other aspects, such as cost and feasibility.

The panel recommends a dose of LMWH 1 mg/Kg/BD SC.

Definition of critical:

•   Requirement for high-level respiratory support: noninvasive ventilation, high-flow oxygen (≥20 litres per minute) or invasive mechanical ventilation
•  OR acute respiratory distress syndrome (PaO2/FiO2 ratio of <300)
•  OR sepsis
•  OR shock