In this review, we discuss the pathophysiologic rationale and current evidence for the use of full-dose heparin (i.e., therapeutic rather than prophylactic dosing) as an anticoagulant in COVID-19. We also discuss a subset of non-anticoagulant effects of heparin that may prove beneficial for the treatment of COVID-19. Finally, we discuss potential risks associated with the implementation of heparin for the treatment of SARS-CoV-2, including but not limited to bleeding and immune-mediated heparin-induced thrombocytopenia (HIT).