Covid-19 patients in Non-Critical Care areas Don’t forget Thromboprophylaxis! (736)

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A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.

Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.

If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.

Note

For guidance on thromboprophylaxis in COVID-19 patients in Critical Care areas (Intensive Care and High Dependency) see separate guidelines on the Guideline Directory on Staffnet.

This document applies to non-pregnant patients only. For advice on  thromboprophylaxis for pregnant patients with suspected or confirmed COVID-19, seek specialist advice and see separate guidance on the Guideline Directory.
•Patients with COVID-19 are at high risk of venous thrombosis
•Pulmonary Embolism (PE) occurs in patients with COVID-19
•Some deaths associated with COVID-19 may be due to PE
•Thromboprophylaxis reduces VTE by 65% in medical inpatients

Using thromboprophylaxis in patients with COVID-19 will likely save lives

  • Prescribe Enoxaparin SC 40mg once daily** for every patient, with no contraindications,admitted to hospital with possible or definite COVID-19
  • **Reduce dose to 20mg od if eGFR <30ml/min/1.73m2 or weight <50kg
  • ** Increase dose to 40mg bd if weight >120kg (see relevant GGC guideline for doseadjustments and monitoring in patients at extremes of body weight)
  • **Contraindications
    • Platelet count < 25 x109/l
    • Receiving anticoagulation for another reason
    • Patient considered to be at high bleeding risk e.g. recent intracranial haemorrhage,untreated inherited/acquired bleeding disorders
    • Trauma with high bleeding risk
    • Active bleeding
    • Heparin induced thrombocytopaenia
    • Within 12 hours of procedures e.g. surgery, lumbar puncture
    • Acute bacterial endocarditis
    • Persistent hypertension (BP ≥230/120)
    • Liver failure and INR>2

In COVID-19 positive patients with ischaemic stroke

  • Prescribe enoxaparin SC 40mg once daily** 48 hours after the onset of stroke andcontinue intermittent pneumatic compression (IPC)
  • Stop IPC 14 days after diagnosis of COVID and continue enoxaparin if no adverseeffects and patient is still immobile

Remember

  • Patients with COVID-19 can develop abnormal coagulation and thrombocytopaenia BUTbleeding symptoms are rare
  • Prolonged PT, APTT and TCT are not a contraindication to administering thromboprophylaxisas long as fibrinogen is ≥1.0 (this is measured automatically by the lab if TCT ≥18secs)
  • For guidance relating to mechanical thromboprophylaxis, see the general thromboprophylaxisguideline in the Adult Therapeutics Handbook

Last reviewed: 05 July 2021

Author(s): Catherine Bagot

Version: 5

Author Email(s): [email protected]

Approved By: NHSGGC Covid-19 Tactical Group (Acute)

Document Id: 736