TY - JOUR
T1 - American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19
T2 - May 2021 update on the use of intermediate-intensity anticoagulation in critically ill patients
AU - Cuker, Adam
AU - Tseng, Eric K.
AU - Nieuwlaat, Robby
AU - Angchaisuksiri, Pantep
AU - Blair, Clifton
AU - Dane, Kathryn
AU - Davila, Jennifer
AU - DeSancho, Maria T.
AU - Diuguid, David
AU - Griffin, Daniel O.
AU - Kahn, Susan R.
AU - Klok, Frederikus A.
AU - Lee, Alfred Ian
AU - Neumann, Ignacio
AU - Pai, Ashok
AU - Righini, Marc
AU - Sanfilippo, Kristen M.
AU - Siegal, Deborah
AU - Skara, Mike
AU - Terrell, Deirdra R.
AU - Touri, Kamshad
AU - Akl, Elie A.
AU - Akl, Imad Bou
AU - Bognanni, Antonio
AU - Boulos, Mary
AU - Brignardello-Petersen, Romina
AU - Charide, Rana
AU - Chan, Matthew
AU - Dearness, Karin
AU - Darzi, Andrea J.
AU - Kolb, Philipp
AU - Colunga-Lozano, Luis E.
AU - Mansour, Razan
AU - Morgano, Gian Paolo
AU - Morsi, Rami Z.
AU - Muti-Schunemann, Giovanna
AU - Noori, Atefeh
AU - Philip, Binu A.
AU - Piggott, Thomas
AU - Qiu, Yuan
AU - Roldan, Yetiani
AU - Schunemann, Finn
AU - Stevens, Adrienne
AU - Solo, Karla
AU - Wiercioch, Wojtek
AU - Mustafa, Reem A.
AU - Schunemann, Holger J.
N1 - Funding Information:
D.R.T. was supported by a career development award from the National Institutes of Health, National Heart, Lung, and Blood Institute (1K01HL135466).
Publisher Copyright:
© 2021 American Society of Hematology. All rights reserved.
PY - 2021/10/26
Y1 - 2021/10/26
N2 - Background: COVID-19-related critical illness is associated with an increased risk of venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in making decisions about the use of anticoagulation for thromboprophylaxis in patients with COVID-19-related critical illness who do not have confirmed or suspected VTE. Methods: ASH formed a multidisciplinary guideline panel that included 3 patient representatives and applied strategies to minimize potential bias from conflicts of interest. The McMaster University Grading of Recommendations Assessment, Development and Evaluation (GRADE) Centre supported the guideline development process by performing systematic evidence reviews (up to 5 March 2021). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the GRADE approach to assess evidence and make recommendations, which were subject to public comment. This is an update on guidelines published in February 2021. Results: The panel agreed on 1 additional recommendation. The panel issued a conditional recommendation in favor of prophylactic-intensity over intermediate-intensity anticoagulation in patients with COVID-19-related critical illness who do not have confirmed or suspected VTE. Conclusions: This recommendation was based on low certainty in the evidence, which underscores the need for additional high-quality, randomized, controlled trials comparing different intensities of anticoagulation in critically ill patients. Other key research priorities include better evidence regarding predictors of thrombosis and bleeding risk in critically ill patients with COVID-19 and the impact of nonanticoagulant therapies (eg, antiviral agents, corticosteroids) on thrombotic risk.
AB - Background: COVID-19-related critical illness is associated with an increased risk of venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in making decisions about the use of anticoagulation for thromboprophylaxis in patients with COVID-19-related critical illness who do not have confirmed or suspected VTE. Methods: ASH formed a multidisciplinary guideline panel that included 3 patient representatives and applied strategies to minimize potential bias from conflicts of interest. The McMaster University Grading of Recommendations Assessment, Development and Evaluation (GRADE) Centre supported the guideline development process by performing systematic evidence reviews (up to 5 March 2021). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the GRADE approach to assess evidence and make recommendations, which were subject to public comment. This is an update on guidelines published in February 2021. Results: The panel agreed on 1 additional recommendation. The panel issued a conditional recommendation in favor of prophylactic-intensity over intermediate-intensity anticoagulation in patients with COVID-19-related critical illness who do not have confirmed or suspected VTE. Conclusions: This recommendation was based on low certainty in the evidence, which underscores the need for additional high-quality, randomized, controlled trials comparing different intensities of anticoagulation in critically ill patients. Other key research priorities include better evidence regarding predictors of thrombosis and bleeding risk in critically ill patients with COVID-19 and the impact of nonanticoagulant therapies (eg, antiviral agents, corticosteroids) on thrombotic risk.
UR - http://www.scopus.com/inward/record.url?scp=85118298426&partnerID=8YFLogxK
U2 - 10.1182/bloodadvances.2021005493
DO - 10.1182/bloodadvances.2021005493
M3 - Review article
C2 - 34474482
AN - SCOPUS:85118298426
SN - 2473-9529
VL - 5
SP - 3951
EP - 3959
JO - Blood advances
JF - Blood advances
IS - 20
ER -