1 Patients with COVID-19 pneumonia managed in hospital
1.1 For patients with COVID-19 pneumonia managed in hospital:
assess the risk of bleeding as soon as possible after admission or by the time of the first consultant review
use a risk assessment tool published by a national UK body, professional network or peer-reviewed journal.
A tool commonly used to develop a treatment plan for patients is the Department of Health VTE risk assessment tool. [amended 18 January 2021]
1.2 Offer pharmacological VTE prophylaxis, unless contraindicated, with a standard prophylactic dose (for acutely ill medical patients) of low molecular weight heparin (LMWH).
1.3 For patients at extremes of body weight or with impaired renal function, consider adjusting the dose of LMWH in line with the summary of product characteristics and locally agreed protocols.
1.4 For patients who cannot have LMWH, use fondaparinux sodium or unfractionated heparin (UFH).
In November 2020, LMWH, fondaparinux sodium and UFH were off label for patients under 18. See NICE's information on prescribing medicines.
1.5 Start VTE prophylaxis as soon as possible and within 14 hours of admission and continue for the duration of the hospital stay or 7 days, whichever is longer.
1.6 For patients who are already having anticoagulation treatment for another condition when admitted to hospital:
continue their current therapeutic dose of anticoagulation unless contraindicated by a change in clinical circumstances
consider switching to LMWH if their current anticoagulation is not LMWH and their clinical condition is deteriorating.
1.7 If a patient's clinical condition changes, assess the risk of VTE, reassess bleeding risk and review VTE prophylaxis.
1.8 For patients who are having advanced respiratory support:
consider increasing pharmacological VTE prophylaxis to an intermediate dose, taking account of body weight and renal function and basing the decision on multidisciplinary or senior opinion, or locally agreed protocols
reassess VTE and bleeding risks daily.
In November 2020, the use of intermediate dosing was an off-label use of parenteral anticoagulants. See NICE's information on prescribing medicines.
1.9 Organisations should collect and regularly review information on bleeding and other adverse events in patients with COVID-19 pneumonia given intermediate doses of pharmacological VTE prophylaxis.
1.10 Ensure that patients who will be completing pharmacological VTE prophylaxis after discharge are able to use it correctly or have arrangements made for someone to help them.
For a short explanation of why we made these recommendations see the rationale section on patients with COVID-19 pneumonia managed in hospital.
Full details of the evidence and the panel's discussion are in the evidence reviews.