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.

• Anticoagulation Dosing Recommendations for COVID-19 Patients - PDF

 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