key: cord-0891894-3romge3h
authors: Long, Brit; Gottlieb, Michael
title: Higher‐dose versus standard‐dose prophylactic anticoagulation in hospitalized patients with COVID‐19
date: 2021-12-01
journal: Acad Emerg Med
DOI: 10.1111/acem.14417
sha: bc2c189ac157daf27134219bed47190686503704
doc_id: 891894
cord_uid: 3romge3h

Coronavirus 2019 (COVID-19) is a global pandemic, which has resulted in over 230 million cases and 4.7 million deaths as of September 25, 2021.1,2 Literature suggests those with moderate or severe disease have increased endothelial activation and inflammation, coagulopathy, and elevated D-dimer levels, which may increase thromboembolic events.2-4.

Summary Heading Higher-dose anticoagulation did not improve survival and increased bleeding, but decreased venous thromboembolism 

COVID-19 is a complex disease, and patients at the beginning of the disease may be prothrombotic, while in later or more severe forms they can develop an increasing bleeding risk. 10 limiting the ability to assess these agents. Moreover, there was heterogeneity in dosing with only two trials using an intermediate dose of anticoagulation rather than full dose. 11, 12 Based on the evidence, we have assigned a color recommendation of Yellow (Unclear if benefit) for higher-dose prophylactic anticoagulation compared to standard-dose in hospitalized patients with COVID-19. The lack of mortality benefit, increase in bleeding, and reduction in VTE suggest a complicated array of effects requiring larger, more rigorous trials and careful subgroup assessments. There are over 30 RCTs currently enrolling patients to evaluate the role of anticoagulation in patients with COVID-19, and we await further data assessing timing, specific patient populations (e.g., elderly, ventilated, pediatric), dosing, and agent.

None.

Brit Long https://orcid.org/0000-0003-4770-8869

Michael Gottlieb https://orcid.org/0000-0003-3276-8375

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