Article Figures & Data
- Figure 1
A short-axis view of the femoral vein (FV) and the femoral artery (FA) at the site of the saphenous vein (SV) inflow. Amorphous echogenicity in the femoral vein, greater than that of the adjacent femoral artery, is suggestive of slow venous flow. The vein was fully compressible, ruling out deep vein thrombosis at the site.
- Figure 4
Algorithm for preventing and treating COVID-19-associated coagulopathy.
FEU = fibrinogen equivalent units
- TABLE 1
Cleveland Clinic approach to anticoagulation prophylaxis and management in COVID-19
Category 1
D-dimer < 3.0 μg/mL FEU Standard prophylaxisCategory 2
D-dimer ≥ 3.0 μg/mL FEU High-intensity prophylaxisCategory 3
Confirmed VTE Full anticoagulationStandard Enoxaparin 40 mg subcutaneously every 24 hours Enoxaparin 40 mg subcutaneously every 12 hours IV heparin per DVT/PE nomogram or enoxaparin 1 mg/kg subcutaneously every 12 hours Renal failure CrCl 10–30 mL/min: Enoxaparin 30 mg subcutaneously every 24 hours
CrCl < 10 mL/min or AKIa: Unfractionated heparin 5,000 U subcutaneously every 12 hours
CRRT: Unfractionated heparin 500 U/hour through circuit
Circuit clotting: IV heparin per ACS nomogramaCrCl < 30 mL/min or AKI: Enoxaparin 40 mg subcutaneously every 24 hours
CrCl < 10 mL/min or AKIa: Unfractionated heparin 7,500 U subcutaneously every 12 hours
CRRT: Unfractionated heparin 500 U/hour through circuit
Circuit clotting: IV heparin per ACS nomogramaIV heparin per DVT/VTE nomogram Obesity Standard > 100 kg: Enoxaparin 40 mg subcutaneously every 12 hours
> 120 kg: Enoxaparin 60 mg subcutaneously every 12 hours> 100 kg: Enoxaparin 60 mg subcutaneously every 12 hours
> 120 kg: Enoxaparin 80 mg subcutaneously every 12 hoursIV heparin per DVT/PE nomogram
or
Enoxaparin 1 mg/kg subcutaneously every 12 hours, up to 150 mg
Above 150 kg use unfractionated heparinRenal failure
CrCl < 30 mL/ min or AKIb≤ 120 kg: 7,500 U every 12 hours
> 120 kg: 10,000 U every 12 hours
CRRT: 500 U/h through circuit
Circuit clotting: IV heparin per ACS nomograma≤ 120 kg: 7,500 U every 8 hours
> 120 kg: 10,000 U every 8 hours
CRRT: 500 U/h through circuit
Circuit clotting: IV heparin per ACS nomogramaIV heparin per DVT/PE nomogram ↵a IV heparin ACS nomogram: initial dose 60-U/kg bolus, then 12 U/kg/hour; target aPTT 49–67 seconds; target heparin anti-Xa 0.2–0.5 units/mL.
↵b AKI definition: doubling of creatinine in 48 hours or anuria.
ACS = acute coronary syndrome; AKI = acute kidney injury; aPTT = activated partial thromboplastin time; CrCl = creatinine clearance; CRRT = continuous renal replacement therapy; DVT = deep vein thrombosis; FEU = fibrinogen equivalent units; IV = intravenous; PE = pulmonary embolism; VTE = venous thromboembolism
Figure 2 (video). Another short-axis view of the femoral vein (center) and the femoral artery (bottom right) at the site of the saphenous vein inflow (top right). Swirling pattern of high echogenicity suggests low-flow state.
Figure 3 (video). Long-axis view of the femoral vein, with spontaneous echogenicity and slow flow.
