VTE is common is critically ill patients with COVID-19. Work-up includes routine testing with CBC, PT, aPTT, fibrinogen, and D-dimer. These tests also correlate with disease severity and mortality. It is recommended to start at least prophylactic-dose anticoagulation in all patients with COVID-19 admitted to the hospital, especially those in the ICU unless contraindicated. If VTE is suspected, confirmatory testing should be obtained to justify full-dose anticoagulation. Some experts support intermediate- or full-dose anticoagulation, even in individuals with COVID-19 who do not have documented VTE, but data on appropriate dosing are limited. In cases of suspected VTE where standard confirmatory testing cannot be obtained, full-dose anticoagulation can be considered in patients with unexplained respiratory failure with stable chest radiograph, along with elevated D-dimer and/or fibrinogen levels. Close monitoring for clinical signs of thrombosis or bleeding is recommended in all patients. Physicians are advised to use their clinical judgment to balance the risks and benefits associated with anticoagulation. Several therapies for COVID-19 are under investigation, some of which may impact thrombotic risk. Participation in clinical trials is encouraged to improve our understanding of pathogenesis and management of coagulopathy in COVID-19. Further trials on anticoagulation doses in patients with COVID-19 are warranted.
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Am J Cardiovasc Drugs. 2020;20(5):393-403. © 2020 Adis Springer International Publishing AG