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Table 2b. Therapeutic Management of Hospitalized Adults With COVID-19

Last Updated: August 8, 2022

Table 2b. Therapeutic Management of Hospitalized Adults With COVID-19
Disease SeverityRecommendations 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-19a,bSee 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.c
Patients who are at high risk of progressing to severe COVID-19a,bRemdesivird (BIII)
Hospitalized and Requires Conventional OxygenePatients who require minimal conventional oxygen Remdesivirf (BIIa)For nonpregnant patients with D-dimer levels above the ULN who do not have an increased bleeding risk:
  • Therapeutic dose of heparinh (CIIa)
For other patients:
  • Prophylactic dose of heparin, unless contraindicated (AI); (BIII) for pregnant patients
Most patientsUse dexamethasone plus remdesivirf (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 baricitinibg or IV tocilizumabg 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 baricitinibg (AI)
  • Dexamethasone plus IV tocilizumabg (BIIa)
If baricitinib, tofacitinib, tocilizumab, or sarilumab cannot be obtained:
  • Dexamethasonei (AI)
Add remdesivir to 1 of the options above in certain patients (CIIa).j
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 baricitinibg (BIIa)
  • Dexamethasone plus IV tocilizumabg (BIIa)
If baricitinib, tofacitinib, tocilizumab, or sarilumab cannot be obtained:
  • Dexamethasonei (AI)
Each recommendation in the Guidelines receives 2 ratings that reflect the strength of the recommendation and the quality of the evidence that supports it. See Guidelines Development for more information.