TY - JOUR
T1 - American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19
T2 - January 2022 update on the use of therapeutic-intensity anticoagulation in acutely ill patients
AU - Cuker, Adam
AU - Tseng, Eric K.
AU - Nieuwlaat, Robby
AU - Angchaisuksiri, Pantep
AU - Blair, Clifton
AU - Dane, Kathryn
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 M.
AU - Skara, Mike
AU - Terrell, Deirdra R.
AU - Touri, Kamshad
AU - Akl, Elie A.
AU - Al Jabiri, Reyad
AU - Al Jabiri, Yazan
AU - Barbara, Angela M.
AU - Bognanni, Antonio
AU - Boulos, Mary
AU - Brignardello-Petersen, Romina
AU - Charide, Rana
AU - Colunga-Lozano, Luis E.
AU - Dearness, Karin
AU - Darzi, Andrea J.
AU - Hussein, Heba
AU - Karam, Samer G.
AU - Mansour, Razan
AU - Morgano, Gian Paolo
AU - Morsi, Rami Z.
AU - Muti-Schunemann, Giovanna
AU - Nadim, Menatalla K.
AU - Philip, Binu A.
AU - Qiu, Yuan
AU - Benitez, Yetiani Roldan
AU - Stevens, Adrienne
AU - Solo, Karla
AU - Wiercioch, Wojtek
AU - Mustafa, Reem A.
AU - Schunemann, Holger J.
N1 - Funding Information:
The authors acknowledge Rob Kunkle, Eddrika Russell, Deion Smith, and Kendall Alexander for their overall coordination of the guideline panel, and they thank the members of the knowledge synthesis team for their contributions to this work: Imad Bou Akl, Emma Cain, Matthew Chan, Phillipp Kolb, Atefeh Noori, Thomas Piggott, and Finn Schu€nemann and the investigators of the BEMICOP, HEP-COVID, and RAPID trials for providing unpublished aggregate data. This work was supported by a career development award from the National Institutes of Health, National Heart, Lung and Blood Institute (1K01HL135466) (D.R.T.).
Publisher Copyright:
© 2022 by The American Society of Hematology.
PY - 2022/9/13
Y1 - 2022/9/13
N2 - Background: COVID-19–related acute illness is associated with an increased risk of venous thromboembolism (VTE). Objective: These evidence-based guidelines from 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 in patients with COVID-19. Methods: ASH formed a multidisciplinary guideline panel that included patient representatives and applied strategies to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process and performed systematic evidence reviews (through November 2021). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations, which were subject to public comment. This is an update to guidelines published in February 2021 as part of the living phase of these guidelines. Results: The panel made one additional recommendation. The panel issued a conditional recommendation in favor of therapeutic-intensity over prophylactic-intensity anticoagulation in patients with COVID-19–related acute illness who do not have suspected or confirmed VTE. The panel emphasized the need for an individualized assessment of risk of thrombosis and bleeding. The panel also noted that heparin (unfractionated or low molecular weight) may be preferred because of a preponderance of evidence with this class of anticoagulants. Conclusion: This conditional recommendation was based on very low certainty in the evidence, underscoring the need for additional, high-quality, randomized controlled trials comparing different intensities of anticoagulation in patients with COVID-19–related acute illness.
AB - Background: COVID-19–related acute illness is associated with an increased risk of venous thromboembolism (VTE). Objective: These evidence-based guidelines from 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 in patients with COVID-19. Methods: ASH formed a multidisciplinary guideline panel that included patient representatives and applied strategies to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process and performed systematic evidence reviews (through November 2021). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations, which were subject to public comment. This is an update to guidelines published in February 2021 as part of the living phase of these guidelines. Results: The panel made one additional recommendation. The panel issued a conditional recommendation in favor of therapeutic-intensity over prophylactic-intensity anticoagulation in patients with COVID-19–related acute illness who do not have suspected or confirmed VTE. The panel emphasized the need for an individualized assessment of risk of thrombosis and bleeding. The panel also noted that heparin (unfractionated or low molecular weight) may be preferred because of a preponderance of evidence with this class of anticoagulants. Conclusion: This conditional recommendation was based on very low certainty in the evidence, underscoring the need for additional, high-quality, randomized controlled trials comparing different intensities of anticoagulation in patients with COVID-19–related acute illness.
UR - http://www.scopus.com/inward/record.url?scp=85134041161&partnerID=8YFLogxK
U2 - 10.1182/bloodadvances.2022007561
DO - 10.1182/bloodadvances.2022007561
M3 - Review article
C2 - 35503027
AN - SCOPUS:85134041161
VL - 6
SP - 4915
EP - 4923
JO - Blood advances
JF - Blood advances
SN - 2473-9529
IS - 17
ER -