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Table 2c. Therapeutic Management of Adults Hospitalized for COVID-19 Based on Disease Severity

Last Updated: September 26, 2022

Table 2c. Therapeutic Management of Hospitalized Adults With COVID-19
Patient DispositionRecommendations for Antiviral or Immunomodulator TherapyRecommendations for Anticoagulant Therapy
Clinical ScenarioRecommendation
Hospitalized for Reasons Other Than COVID-19 Patients with mild to moderate COVID-19 who are at high risk of progressing to severe COVID-19aSee Therapeutic Management of Nonhospitalized Adults With COVID-19.For patients without an indication for therapeutic anticoagulation:
  • Prophylactic dose of heparin, unless contraindicated (AI); (BIII) for pregnant patients
Hospitalized but Does Not Require Oxygen SupplementationAll patientsThe Panel recommends against the use of dexamethasone (AIIa) or other systemic corticosteroids (AIII) for the treatment of COVID-19.b
Patients who are at high risk of progressing to severe COVID-19aRemdesivirc (BIII)
Hospitalized and Requires Conventional OxygendPatients who require minimal conventional oxygen Remdesivire (BIIa)For nonpregnant patients with D-dimer levels above the ULN who do not have an increased bleeding risk:
  • Therapeutic dose of heparing (CIIa)
For other patients:
  • Prophylactic dose of heparin, unless contraindicated (AI); (BIII) for pregnant patients
Most patientsUse dexamethasone plus remdesivire (BIIa). If remdesivir cannot be obtained, use dexamethasone (BI).
Patients who are receiving dexamethasone and who have rapidly increasing oxygen needs and systemic inflammationAdd PO baricitinibf or IV tocilizumabf to 1 of the options above (BIIa).
Hospitalized and Requires HFNC Oxygen or NIVMost patientsPromptly start 1 of the following, if not already initiated:
  • Dexamethasone plus PO baricitinibf (AI)
  • Dexamethasone plus IV tocilizumabf (BIIa)
If baricitinib, tofacitinib, tocilizumab, or sarilumab cannot be obtained:
  • Dexamethasoneh (AI)
Add remdesivir to 1 of the options above in certain patients (CIIa).i
For patients without an indication for therapeutic anticoagulation:
  • Prophylactic dose of heparin, unless contraindicated (AI); (BIII) for pregnant patients
For patients who are started on a therapeutic dose of heparin in a non-ICU setting and then transferred to the ICU, the Panel recommends switching to a prophylactic dose of heparin, unless there is another indication for therapeutic anticoagulation (BIII).
Hospitalized and Requires MV or ECMOMost patientsPromptly start 1 of the following, if not already initiated:
  • Dexamethasone plus PO baricitinibf (BIIa)
  • Dexamethasone plus IV tocilizumabf (BIIa)
If baricitinib, tofacitinib, tocilizumab, or sarilumab cannot be obtained:
  • Dexamethasoneh (AI)
Rating of Recommendations: A = Strong; B = Moderate; C = Weak
Rating of Evidence: I = One or more randomized trials without major limitations; IIa = Other randomized trials or subgroup analyses of randomized trials; IIb = Nonrandomized trials or observational cohort studies; III = Expert opinion