COVID-19 ThromboprophylaXIs Study of Novel FXIa Inhibitor Frunexian (EP-7041) in ICU Patients

Inclusion Criteria: * SARS-CoV-2 test (by local evaluation) positive * Symptom severity and general risk of decompensation warrants, in the opinion of the treating clinician, admission to/care in an intensive care unit setting * Patient or legally authorized representative (LAR) able and willing to provide written informed consent * No contraindication to receiving anticoagulation * At least one D-dimer value ≥2 times local ULN (within 72 hours of hospital admission) Exclusion criteria Patients who meet ANY of the following criteria are not eligible for inclusion: * Moribund patient not expected to survive 24 hours * ICU length of stay \> 24 hours prior to initiation of frunexian infusion * Existing venous thromboembolism * Known immune compromise (HIV/AIDS, chemotherapy, chronic corticosteroid therapy, transplant patient, etc.) * Active cancer diagnosis * Pregnant, lactating, or parturient woman * bodyweight \<40kg * hemoglobin \<8.0 g/L in the last 72 hours * platelet count \<50 x 109/L in the last 72 hours * known fibrinogen \<1.5 g/L (if testing deemed clinically indicated by the treating physician prior to the initiation of anticoagulation) * known INR \>1.8 (if testing deemed clinically indicated by the treating physician prior to the initiation of anticoagulation) * patient already on therapeutic anticoagulation at the time of screening (low or high dose nomogram UFH, LMWH, warfarin, or any regular dose of a direct oral anticoagulant) * patient on dual antiplatelet therapy, when at least one of the agents cannot be stopped safely * history of spontaneous intracranial bleeding; gastrointestinal bleeding requiring hospitalization and/or transfusion within prior 3 months * major surgery within prior 30 days * known bleeding within the last 30 days requiring emergency department presentation or hospitalization * known history of a bleeding disorder of an inherited or active acquired bleeding disorder * recent (\<48 hours) or planned spinal or epidural anesthesia or puncture * anticipated transfer to another hospital that is not a study site within 72 hours * enrollment in other trials related to anticoagulation or antiplatelet therapy * use of pneumatic compression devices for thromboprophylaxis * Failure to meet ALL Inclusion Criteria