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Table 3 Pediatric COVID-19 anticoagulation regimens

From: Practical approach to COVID-19: an Egyptian pediatric consensus

a. Doses of anticoagulation

 

Prophylaxis

Therapeutic dose

 Heparin

100–150 units/kg IV once

Infusion

• < 1 year—loading dose of 75 units/kg IV, then 28 units/kg/h IV as initial maintenance dose

• 1 year—Loading dose of 75 units/kg IV, then 20 units/kg/h IV as initial maintenance dose

Intermittent IV injection

• Initially give 50–100 units/kg IV infusion, then 100 units/kg IV infusion q4hr as a maintenance dose

 Enoxaparin

< 2 months: 0.75 mg/kg SC q12h

≥ 2 months: 0.5 mg/kg SC q12hr

< 2 months: 1.5 mg/kg SC q12h

≥ 2 months: 1 mg/kg SC q12hr

b. Indications and contraindications of anticoagulation

 Indications for prophylactic anticoagulation

All admitted patients with moderate COVID-19, i.e., any patient with pneumonia

All moderate and severe cases who don't meet the therapeutic indications

 Indications for therapeutic anticoagulation

All ICU patients

O2 sat < 92% or tachypnea for age

O2 requirements ≥ 4 L on nasal cannula

Elevated D-dimer 3x upper level of normal

Elevated CRP

 Contraindications

Patients who are at high risk of bleeding

Platelets < 50,000

INR > 1.5

Active bleeding