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