Mount Sinai COVID-19 Anticoagulation Algorithm

Posted by

Salient features:

This article focuses on:

  • Definition of high risk for progression to ICU
  • Rationale for early anticoagulation
  • Rationale for choice of anticoagulant

Detailed summary:

Definition of high risk for progression to ICU

  • Clinicians should consider combination of exam findings ( e.g, labored breathing, RR> 24, decreased O2 requirement (e.g. >4LNC) and lab biomarkers (e.g: elevated CRP, elevated creatinine, rising d-dimer >1.0)

Rationale for early anticoagulation

  • Pathophysiology of COVID-19 associated respiratory disease is consistent with pulmonary vascular thromboemboli with increased dead space ventilation
  • Autopsy studies have demonstrated venous thromboembolism in deceased coronavirus patients.
  • Early anticoagulation is necessary to prevent propagation of microthrombi at disease presentation.
  • Anticoagulation may be presented with decreased mortality

Rationale for choice of anticoagulant

  • Heparins bind tightly to COVID-19 spike proteins
  • Heparins also downregulate IL-6 and directly dampen immune activation
  • DOACs do not appear to have these anti-inflammatory properties
  • Rivaroxaban can be used in place of Apixaban in this algorithm

Leave a Reply

Your email address will not be published. Required fields are marked *