Skip to main content

Table 7 CDC and societal recommendations regarding anticoagulation on discharge and correction of active bleeding in COVID-19

From: Comparison of published guidelines for management of coagulopathy and thrombosis in critically ill patients with COVID 19: implications for clinical practice and future investigations

 

Recommendations regarding anticoagulation on discharge

Correction of active bleeding

CDC

Routine venous thromboprophylaxis post-discharge is not recommended. FDA-approved prophylactic anticoagulation regimen (rivaroxaban and betrixaban) can be considered if high risk for VTE and low risk for bleeding using criteria from clinical trials.

Not mentioned

ISTH-IG

No specific recommendations

Transfuse to keep platelet count > 50 × 109/L, fibrinogen > 1.5 g/L, PT ratio < 1.5

ACF

No evidence for anticoagulation beyond hospitalization, but reasonable to consider if low risk for bleeding and high risk for VTE including intubated, sedated, and paralyzed for multiple days.

Not mentioned

ASH

Reasonable to consider FDA-approved post-discharge prophylactic anticoagulation regimen (rivaroxaban and betrixaban) or aspirin if criteria from trials for post-discharge thromboprophylaxis are met.

Transfuse one adult unit of platelets if platelets < 50 × 109/L, give 4 units of plasma if INR > 1.8, and fibrinogen concentrate (4 g) or cryoprecipitate (10 u) if fibrinogen < 1.5 g/L. In patients with severe coagulopathy and bleeding can consider 4F-PCC (25 u/kg) instead of plasma.

ACCP

Can be considered in patients who are at low risk of bleeding if emerging data suggests a clinical benefit.

Not mentioned

SCC-ISTH

Either LMWH or FDA-approved post-discharge prophylactic anticoagulation regimen (rivaroxaban and betrixaban) should be considered in patients with high VTE risk criteria. Duration is 14 days at least and up to 30 days. Of note, they report that none of the respondents recommended aspirin for post-discharge thromboprophylaxis.

Not mentioned

ACC

Reasonable to consider extended prophylaxis with LMWH or DOACs for up to 45 days in patients at high risk for VTE (i.e., D-dimer > 2 times the upper limit, reduced mobility, active cancer) and low risk of bleeding.

Transfuse platelets to maintain platelets > 50 × 109/L in DIC and active bleeding or if platelets < 20 × 109/L in patients at high risk of bleeding or requiring invasive procedures. FFP (15 to 25 mL/kg) in patients with active bleeding with either prolonged PT or PTT ratios (> 1.5 times normal) or decreased fibrinogen (< 1.5 g/L). Fibrinogen concentrate or cryoprecipitate in patients with persisting severe hypofibrinogenemia (< 1.5 g/L). Prothrombin complex concentrate if FFP is not possible. Tranexamic acid should not be used routinely in patients with COVID-19-associated DIC given the existing data.

  1. Abbreviations: COVID-19 coronavirus disease 2019, DIC disseminated intravascular coagulation, DOAC direct oral anticoagulant, FDA Food and Drug Administration, FFP fresh frozen plasma, g grams, kg kilograms, PT prothrombin time, VTE venous thromboembolism, INR international normalized ratio, L liter, LMWH low molecular weight heparin, mL milliliter, PT prothrombin time, PTT partial prothrombin time, u units, 4F-PCC four-factor prothrombin complex concentrate