Below are the latest updates to the EHC COVID-19 clinical guidelines.
Summary of major changes:
1. Anticoagulation. In light of the recent NIH announcement, EHC is no longer recommending empiric therapeutic anticoagulation outside of suspected or confirmed DVT/PE or prior AC. EHC currently recommends either standard or intermediate VTE prophylactic dosing based on clinical risk factors. In the absence of contraindication to anticoagulation, use intermediate VTE ppx dosing for patients who are critically ill or who require respiratory support beyond O2 via NC(eg. HFNC, NIV, MV). Dosing is adjusted for extremes of weight, however most patients will require either enoxaparin 40mg q24h (standard dose) or enoxaparin 40mg q12h (intermediate dose). In the setting of CrCl<30, heparin SQ is preferred for VTE prophylaxis.
2. Immunomodulatory therapy. Reflecting preliminary data from REMAP-CAP suggesting benefit of the IL-6 inhibitor Tocilizumab in critically ill patients requiring organ support, EHC is now recommending early administration of Tocilizumab in patients with confirmed or suspected COVID-19 requiring respiratory support beyond O2 via NRB (eg. HFNC, NIV, MV) or vasopressors without contraindication (see full guidelines).
3. Pregnancy. Recommendations regarding the management of pregnant patients with COVID-19 have been added to corresponding therapeutic subsections.EHC COVID-19 Clinical Care Guidelines 2-5-21
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