COVID-19 Coagulopathy: Current knowledge and guidelines on anticoagulation.
Joshua K Salabei, Troy J Fishman, Zekarias T Asnake and 2 others
PMID 33524866WHAT IT FOUND
Current guidelines recommend prophylactic low-molecular-weight heparin for all hospitalized COVID-19 patients unless active bleeding, severe thrombocytopenia, or very low fibrinogen is present.
Therapeutic anticoagulation without confirmed clots remains controversial and is not yet supported by randomized trials.
Key findings
01Prophylactic dose LMWH is recommended for all hospitalized COVID-19 patients unless there is active bleeding, platelet count < 25 × 10^9 /L, or fibrinogen levels < 0.5 g/L.
02Abnormal PT or aPTT is not a contraindication for pharmacological thromboprophylaxis; if pharmacological prophylaxis is contraindicated, mechanical thromboprophylaxis should always be used.
03The benefit of therapeutic anticoagulation in critically ill patients without confirmed VTE is currently controversial and awaits data from randomized controlled trials.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a narrative review, not a systematic review or meta-analysis, so it may not capture all available evidence. Guidelines cited are general and require institution-specific modifications, particularly regarding D-dimer monitoring protocols. The review notes that evidence for therapeutic anticoagulation is based on retrospective and cross-sectional studies, lacking randomized trial confirmation at the time of writing.
Declared interests
None declared.
The easy way to misread this
Do not interpret this review as evidence that therapeutic (high-dose) anticoagulation improves outcomes for all critically ill patients. The authors state that this benefit is currently controversial and unproven without randomized trial data, so standard prophylactic dosing remains the guideline-supported default unless specific institutional protocols or confirmed VTE dictate otherwise.