American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: January 2022 update on the use of therapeutic-intensity anticoagulation in acutely ill patients

Adam Cuker, Eric K. Tseng, Robby Nieuwlaat, Pantep Angchaisuksiri, Clifton Blair, Kathryn Dane, Maria T. DeSancho, David Diuguid, Daniel O. Griffin, Susan R. Kahn, Frederikus A. Klok, Alfred Ian Lee, Ignacio Neumann, Ashok Pai, Marc Righini, Kristen M. Sanfilippo, Deborah M. Siegal, Mike Skara, Deirdra R. Terrell, Kamshad TouriElie A. Akl, Reyad Al Jabiri, Yazan Al Jabiri, Angela M. Barbara, Antonio Bognanni, Mary Boulos, Romina Brignardello-Petersen, Rana Charide, Luis E. Colunga-Lozano, Karin Dearness, Andrea J. Darzi, Heba Hussein, Samer G. Karam, Razan Mansour, Gian Paolo Morgano, Rami Z. Morsi, Giovanna Muti-Schunemann, Menatalla K. Nadim, Binu A. Philip, Yuan Qiu, Yetiani Roldan Benitez, Adrienne Stevens, Karla Solo, Wojtek Wiercioch, Reem A. Mustafa, Holger J. Schunemann

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)4915-4923
Number of pages9
JournalBlood Advances
Volume6
Issue number17
DOIs
StatePublished - Sep 13 2022

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