======Anticoagulation guidelines for COVID======

^  Level  ^  Criteria  ^  CrCl ≥30  ^  CrCl <30  ^
| 1 | No VTE \\ D-dimer < 6.0 | BMI ≤ 30: Enoxaparin 40 mg subcutaneous Qday \\ BMI > 30: Enoxaparin 40mg subcutaneous Q12hr | Enoxaparin 30 mg subcutaneous Qday or UFH 5,000 units subcutaneous Q8hrs |
| 2 | No VTE and any of the following: \\ • D-dimer > 6.0 \\ • D-dimer increased by > 2.0 despite 48hr of prophylactic LMWH or UFH \\ • Inability to dialyze due to clotting in line, filter, or machine | Enoxaparin 0.5 mg/kg subcutaneous Q12hr | Low Dose IV Unfractionated Heparin Protocol |
| 3 | KNOWN or SUSPECTED VTE, or \\ Inability to dialyze due to clotting in line, filter, or machine despite Level 2 anticoagulation \\ (Consider if FiO2 > 50% or O2 > 6L/min for >4 hrs while on Level 1 or 2 anticoagulation) | Enoxaparin 1 mg/kg subcutaneous Q12hr | DVT/PE IV Unfractionated Heparin Protocol \\ - Use approved order set \\ - Consider eliminating bolus if recent Anti-Xa at/near goal or LMWH recently dosed |
| 4 | Any of the following while therapeutic on treatment dose of unfractionated heparin or enoxaparin: \\ (1) VTE \\ (2) Suspected HITT \\ (3) D-dimer persistently >20 \\ (4) Inability to dialyze due to clotting in line, filter, or machine despite Level 3 anticoagulation | Check: \\ - Cardiolipin Ab Panel \\ - HITT screen (if indicated) \\ - Antithrombin III activity \\ - Beta-2 Glycoprotein Ab Panel \\ Options: \\ - Consider using Anti-Xa for LMWH dosing \\ - If patient has breakthrough clotting while on therapeutic LMWH (and HIT is not suspected), consider increasing LMWH dose by 25% \\ - If HIT is suspected, consider switching to argatroban or fondaparinux (fondaparinux requires less nurse/phlebotomy contact with patient) \\ - If emboli are suspected, consider thrombolysis ||