Table 6 CDC and societal recommendations regarding monitoring of anticoagulation in COVID-19
| Â | Monitoring of patients receiving LMWH | Monitoring of patients with elevated PTT receiving therapeutic anticoagulation | Monitoring of patients receiving therapeutic anticoagulation |
|---|---|---|---|
CDC | Not mentioned | Not mentioned | Per standard of care for patients without COVID-19 |
ISTH-IG | Advised in patients with severe renal impairment | Not mentioned | Not mentioned |
ACF | Do not recommend dosing based on anti-Xa levels given lack of evidence on outcomes for thrombosis or bleeding | Recommend monitoring anti-Xa receiving UFH. LMWH use allows additional monitoring to be avoided. | Recommend monitoring anti-Xa levels to monitor UFH due to potential baseline PTT abnormalities. Reasonable to monitor anti-Xa or PTT in patients with normal baseline PTT levels and do not exhibit heparin resistance (> 35,000 u heparin over 24 h). |
ASH | Not mentioned | May necessitate anti-Xa monitoring of UFH given artefactual increases in PTT. | May necessitate anti-Xa monitoring of UFH given artefactual increases in PTT. |
ACCP | Body weight adjusted doses for LMWH do not require laboratory monitoring in majority of patients. | Not mentioned | Monitor anti-Xa levels in all patients receiving UFH given potential of heparin resistance. |
SCC-ISTH | No specific recommendations. Mentions that LMWH may be advantageous over other agents for parenteral anticoagulation due to lack of routine monitoring. | Not mentioned | No specific recommendations. Mentions that expert clinical guidance statements and clinical pathways from large academic healthcare systems target an anti-factor Xa level of 0.3–0.7 IU/mL for UFH. |
ACC | Not mentioned | Not mentioned | Not mentioned |