Pharmacotherapy Considerations in Hospitalized Patients With COVID-19 Pneumonia

William Pruett, MD; Lee E. Morrow, MD, MSc, FCP, FCCP, FCCM, ATSF; Mark A. Malesker, PharmD, FCCP, FCCP, FCCM, FASHP, BCPS


US Pharmacist. 2020;45(44020):HS9-HS16. 

In This Article


The role of anticoagulation in COVID-19 is one of the most contentious and heavily debated topics. The only agreed-upon paradigm in this realm is that the current ICU standard of care—regardless of COVID-19 status—is for mechanically ventilated patients to receive deep venous thrombosis (DVT) prophylaxis.[5,27] After multiple postmortem case studies described an abundance of microthrombi in various organs of COVID-19–infected patients—even though the exact mechanism of microthrombus formation was not well understood—clinicians increasingly discussed liberal application of therapeutic anticoagulation.[8] With the subsequent realization that elevated d-dimer concentration is a predictor of mortality, various institutions began to formally endorse aggressive anticoagulation in patients with COVID-19 despite a paucity of supporting evidence.[28–30] Again, there was a general lack of consensus as to when anticoagulation should be started, the optimal agent(s), effective dosing, and when to discontinue therapy. This remains an area of significant disagreement, and the NIH recently suggested that any anticoagulation strategy beyond routine DVT prophylaxis should be used only in clinical trials, given "insufficient data."[31]