Page 43 - COVID-19-Mortality-review-in-Malaysia-and-updates-on-clinical-management-of-COVID-19

Addressing Hypercoagulopathy

There is a large amount of literature out there now stating that COVID-19 causes

hypercoagulability. We had four to five patients who had confirmed pulmonary
embolism due to COVID-19. We divided how we should address hypercoagulability

into 3 treatment groups:
● Full dose anticoagulation
● Prophylaxis

● High prophylactic dose anticoagulation

The first two groups are quite clear. The current data says we need to do a full dose
of anticoagulation. For example, if enoxaparin is used, we have to use 1 mg/kg 12
hourly for patients with normal renal function. A full dose of anticoagulant should be

started if
● anybody with confirmed venous thromboembolism,

● anybody with suspected pulmonary embolism i.e. they have sudden deterioration
in oxygenation or hemodynamic instability, acute cor pulmonale or

● anybody with clotting of vascular devices (eg, venous, arterial devices, and

hemodialysis devices).

I was told by my intensivist, Dr Lee CK that the Continuous Renal Replacement

Therapy (CRRT) is more often clotted in COVID-19 patients, more than other critically
ill patients. So all these patients should get their full dose of enoxaparin.

For prophylaxis, 30 to 40 milligrams enoxaparin daily depending on renal function
will be given. We give it to all patients who require supplemental oxygen. For anybody