F0 level is mild, if you are taking anticoagulation according to the underlying disease, it should be maintained, F0 is moderate, depending on the test results.
One of the dangerous complications of Covid-19 is a blood clotting disorder, causing micro-thrombosis in the lungs (causing pulmonary congestion, shortness of breath and heart failure) and other organs, even causing blockage of blood vessels. large blood vessels, which can lead to myocardial infarction, stroke, pulmonary embolism… Coagulation disorders along with inflammatory response disorders are the two main consequences of the cytokine “storm” that causes respiratory failure and failure of other organs. important organs of the body. Therefore, the use of anticoagulants in the prevention and treatment of complications related to coagulation disorders in Covid-19 patients is very important.
Unlike anti-inflammatory corticosteroids, which are not used for prevention due to many dangerous effects, anticoagulants can be used for prevention relatively safely. Below are instructions for using anticoagulants for F0 from Dr. Nguyen Huy Hoang, Hyperbaric Oxygen Center of Vietnam – Russia Tropical Center.
F0 asymptomatic or mild
According to the Ministry of Health, mild F0 is a person with SpO2 above 96% and breathing rate less than 20 times/minute. Moderate F0 is a person with SpO2 from 94% to 96%, respiratory rate 20-25 breaths/minute, X-ray lesions <50% or mild F0 but with underlying disease.
– If F0 is taking anticoagulants according to the underlying disease, continue to maintain.
– If F0 has high risk, underlying disease such as hypertension, diabetes, cancer, chronic lung disease, coronary artery disease, history of blood clots, obesity, use prophylactic dose.
F0 medium level
Use booster dose and therapeutic dose according to test results. The test is based on the following criteria:
– CRP (critical test to identify and evaluate inflammation or infection) less than 15mg/L, use booster dose; above 15mg/L in therapeutic doses.
– Ferritin (check the amount of iron present in the body) below 1,000 ng/ml with booster dose; over 1,000 ng/ml in therapeutic doses.
– D-dimer (a biochemical test used to diagnose thrombosis in the blood) increased 2 – 5 times the normal threshold, using an enhanced prophylactic dose; more than 5 times the threshold of normal or doubled within 48 hours of the therapeutic dose.
– IL-6 if 15 – 40 pg/ml, use prophylactic dose; over 40 pg/ml in therapeutic doses.
– Lymphocytes have not decreased, refer to other criteria; Lymphocyte decrease below 0.8G/L, use therapeutic dose. The main job of lymphocytes is to strengthen the body’s resistance to fight bacteria, parasites and pathogens.
– Neutrophils less than 10 G/L, use prophylactic dose; above 10G/L, use therapeutic dose. Neutrophils are the body’s main defense mechanism against bacterial and fungal infections.
Contraindications: anticoagulation if F0 is bleeding, recent cerebral hemorrhage, Fibrinogen <0.5g/L, acute infective endocarditis. Use caution if F0 is having thrombocytopenia.
People with normal kidney function
The following prophylactic and therapeutic doses are for F0 patients with normal renal function, if renal function declines, the patient should consult a doctor.
Prophylaxis or booster dose for 7-10 days:
The patient chooses one of the following drugs:
– Enoxaparin (Lovenox or other brand names): with BMI < 30, subcutaneous injection 40mg once daily; BMI > 30, 40mg subcutaneous injection, maybe 1-2 times per day. Enhanced prophylactic dose: at any BMI, 0.5 mg/kg body weight subcutaneously, twice daily.
– Rivaroxaban (Xarelto or other brand names) 10-20mg, taken once/24 hours.
– Apixaban (Eliquis or other brand names) 2.5mg orally 2 times/24 hours.
– Dabigatran (Pradaxa or other brand names) 220mg orally once/24 hours.
Therapeutic dose, used for 2 – 6 weeks, if there is evidence of thrombosis, use 3 – 6 months:
The patient chooses one of the following drugs:
– Enoxaparin (Lovenox or other brand names): with BMI <30, subcutaneous injection 1mg/kg body weight, 2 times daily; BMI > 30, subcutaneous injection 0.8mg/kg body weight, 2 times per day.
– Rivaroxaban (Xarelto or other brand names) 15mg orally 2 times/24 hours.
– Apixaban (Eliquis or other brand names) 5 – 10mg, taken 2 times/24 hours.
– Dabigatran (Pradaxa or other brand names) 150mg, taken 2 times/24 hours.
When taking therapeutic doses, patients need to take additional anticoagulants of the Acecumarol group (Sintrom or other brand names), Warfarin (Coumadin or other brand names) to achieve an INR in the range of 2 – 3.
– For pregnant women, use only Enoxaparin (Lovenox) and dose based on D-dimer test.
If the patient is taking aspirin, continue with the prophylactic dose, if taking the therapeutic dose, stop aspirin.
If the patient is taking an oral anticoagulant other than aspirin, stop and switch to heparin or enoxaparin (Lovenox).
– If you have any symptoms of bleeding or chest pain, swelling of the extremities, you should contact your doctor immediately.
– If long-term treatment, patients need to perform monitoring tests such as INR, Fibrinogen, D-dimer, anti-Xa…