Guidelines
Anticoagulation for Asymptomatic Patient

Anticoagulation for Asymptomatic Patient

Recommendations

No anticoagulation recommended

Enoxaparin prophylaxis recommended

  • Consultation to pharmacy to manage enoxaparin prophylaxis and titrate doses based on anti-Xa levels is recommended. 
  • A recent cohort study in pediatric patients with severe COVID-19 found breakthrough VTE's occurring in those on fixed-dose enoxaparin compared to those whose doses were titrated based on anti-Xa levels.

Risk Factors for VTE

  • Central venous catheter
  • Mechanical ventilation
  • Prolonged length of stay (eg, anticipated >3 days)
  • Complete immobility (eg, Braden Q Mobility Score = 1)
  • Obesity (ie, BMI >95th percentile)
  • Active malignancy, nephrotic syndrome, cystic fibrosis, exacerbation, sickle cell disease vaso-occlusive crisis, or flare of underlying inflammatory disease (eg, lupus, juvenile idiopathic arthritis, inflammatory bowel disease)
  • Congenital or acquired cardiac disease with venous stasis or impaired venous return
  • Previous history of VTE
  • First-degree family history of VTE before age 40 years or unprovoked VTE
  • Known thrombophilia
  • Age >12 years (or pubertal or post-pubertal)
  • Receiving estrogen-containing oral contraceptive pill
  • Status-post splenectomy for underlying hemoglobinopathy