In a new update to Australian guidelines for the clinical care of patients with COVID-19, prophylactic doses of anticoagulants, preferably LMWH have been recommended for the prevention of VTE.

“Use prophylactic doses of anticoagulants, preferably LMWH (e.g. enoxaparin 40 mg once daily or dalteparin 5000 IU once daily) in adults with moderate COVID-19 or other indications, unless there is a contraindication, such as risk for major bleeding,” the guidelines said.

“Where severe acute kidney disease is present, unfractionated heparin or renally adjusted doses of LMWH may be used (e.g. enoxaparin 20 mg once daily or dalteparin 2500 IU once daily).”

As with many aspects of care in COVID-19, the recommendation is made in an evidence-free zone.

Similarly there is no systematically collected evidence regarding the cost-benefit of such treatment.

“The panel believes that the benefits of pharmacologic prophylaxis among medically ill patients outweigh potential harm, such as bleeding caused by this prophylaxis. The panel believes that this will also apply to patients with COVID-19 and therefore recommend pharmacologic prophylaxis.”

The guidelines said the recommendation for use of DVT prophylaxis was adapted from other published recommendations including that of the International Society on Thrombosis and Haemostasis (ISTH) and the British Haematological Society.

A recommendation regarding the use of higher than standard prophylactic doses is pending.