This guideline covers thromboprophylaxis specifically in the non-pregnant COVID-19 population. Seek specialist obstetric advice for thromboprophylaxis in pregnant women with suspected or confirmed COVID-19 infection.
For guidance on thromboprophylaxis in patients who are either not suspected of having COVID-19 or are not confirmed COVID-19 positive, see the main Thromboprophylaxis for Medical and Surgical Patients guideline.
Patients with COVID-19 are at high risk of developing a venous thromboembolism (VTE) and it is essential that effective thromboprophylaxis is considered for all patients admitted to hospital with suspected or confirmed COVID-19 infection. Using thromboprophylaxis in patients with COVID-19 will likely save lives.
Thromboprophylaxis management in COVID patients differs depending on whether a patient is being treated within a critical care area (intensive care unit, high dependency unit) or a non-critical care area.
There are two guidelines to consider, depending on whether the patient is on renal replacement therapy or not. Refer to:
Note: The above documents contain some links to NHSGGC StaffNet that are only active if accessing via a NHS computer.
Prescribe enoxaparin SC 40mg once daily (at 6pm).
Reduce dose to enoxaparin SC 20mg once daily if eGFR <30ml/minute/1.73m2.
If weight is <50kg reduce the dose to enoxaparin SC 20mg once daily.
If weight is >120kg, with normal renal function, consider enoxaparin SC 40mg twice daily (unlicensed dose) especially if multiple thrombotic risk factors are present (requires monitoring of anti-Xa levels).
For more information see guidelines on NHSGGC StaffNet / Acute / Venous thromboembolism / Diagnosis and Treatment (link only active if accessing via NHS computer).
Prescribe enoxaparin SC 40mg once daily 48 hours after the onset of stroke and continue intermittent pneumatic compression (IPC). If eGFR <30ml/minute/1.73m2 then reduce dose to enoxaparin SC 20mg once daily.
Stop IPC 14 days after diagnosis of COVID-19 and continue enoxaparin if no adverse effects and patient is still immobile.
Patients with COVID-19 can develop abnormal coagulation and thrombocytopenia but bleeding symptoms are rare. Prolonged prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin clotting time (TCT) are not a contraindication to administering thromboprophylaxis as long as fibrinogen is ≥1 (this is measured automatically by the lab if TCT ≥18secs).
For further details of assessment of VTE and bleeding risk, and monitoring requirements (in addition to those listed here), see the main Thromboprophylaxis for Medical and Surgical Patients guideline.
Content updated December 2020.