Patient Treatment Guidelines

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Anticoagulation Dosing Recommendations for COVID-19 Patients

Last updated: Dec. 9, 2020

The following dosing recommendation chart apply to all COVID-19 positive and rule out adult patients at UMMC.

 Additional monitoring recommendations:

  • Review prior to admission meds to ensure not previously on Therapeutic Anticoagulation

    • If so, please maintainTherapeutic Anticoagulation
  • Repeat platelet count (CBC) 1-2x weekly

  • If patient labeled ‘Resolved’ or considered convalescing, discuss possibility of reducing to standard prophylaxis

    • If dosing reduced to standard prophylaxis dosing, pharmacy to sign off

  • Consider checking TEG and fibrinogen if there is progressive organ failure or clinical thrombosis

**Providers - Consider empirically continuing prophylaxis for post-discharge in patients with hypercoagulability. Should consider if patient has ongoing VTE risk factors or may benefit from extended post-hospital VTE prophylaxis

Enoxaparin Anti-Xa Serum Concentration Monitoring

Serum Anti-Xa peak (Heparin, Anti-Xa Lab Order) should be drawn 4 hours after the third or subsequent enoxaparin dose (no sooner than the third dose). Repeat serum Anti-Xa peak with each dose adjustment, and with any significant change in renal function.

*Results can be found in the Special Coag Studies Misc. under the Results Review.

¥Enhanced Prophylactic Enoxaparin Dose Adjustment Based on Anti-Xa Concentration

Anti-Xa < 0.2 IU/mL: Increase enoxaparin dose by 10 - 20 mg to the nearest syringe size

Anti-Xa 0.2 - 0.5 IU/mL: no change

Anti-Xa > 0.5 IU/mL: Decrease enoxaparin dose by 10 - 20 mg to the nearest syringe size

Disclaimer

These documents and content on this website are guidelines during the COVID-19 pandemic. Because new information is released rapidly, these documents can be updated or changed at any time. These documents are in no way to be considered as a standard of care and the content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The information in these documents is provided with no guarantees, accuracy, or timeliness. All content in these documents and website are for informational purposes only and do not constitute the providing of medical advice.