There is a paucity of pharmacologic therapies for COVID-19. Although heparin may prove beneficial in treating the coagulopathy of this disease, utilization of therapeutic anticoagulation before the development of thrombosis in COVID-19 has not been systematically evaluated. Additionally, although heparin is known to possess non-anticoagulant effects that may be beneficial in COVID-19 (i.e., direct antiviral and anti-inflammatory), the balance between its benefits and risks should be considered. Given the potential benefits (and uncertain risks) of therapeutic heparin (see Fig. 3), tempered by the failures of previous studies targeting coagulopathy in critical illness, randomized clinical trials of heparin in COVID-19 are urgently needed.