Table 4

Recommendations for patient on pre-existing thrombotic therapy from the global COVID-19 thrombosis Collaborative group37 38 41

Patients with mild COVID-19 (outpatient)38
  • Mild COVID-19 is not a known risk of anti-thrombotic agents; continue taking antithrombotic agents as recommended for patients on antithrombotics for prior known thrombotic disease

Patients with moderate to severe COVID-19 with suspected or confirmed DIC without overt bleeding on chronic therapeutic anticoagulation38
  • Weigh anticoagulation indication against bleeding risk, consider dose adjustment or discontinuation

  • Majority of the authors recommend reducing anticoagulation intensity barring exceedingly high thrombosis risk

Patients with moderate to severe COVID-19 without overt bleeding on dual antiplatelet therapy38
  • Individualised decisions for antiplatelet therapy

  • In general, consider continuing dual antiplatelet therapy for platelet counts >50 000; reduce to single antiplatelet for platelet count 25 000–50,000; discontinue antiplatelets if platelet count <25 000

Patients with moderate to severe COVID-19 on existing anticoagulation for other diseases, for example, atrial fibrillation
  • Consider changes to therapeutic low-molecular-weight heparins while an inpatient for safer monitoring profile and less interactions with other drugs37

  • If breakthrough VTE occurs while on oral anticoagulants recommend changing over to low molecular weight heparins37 41

  • If significant renal dysfunction present, consider unfractionated heparin

  • VTE, venous thromboembolism.