American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19

Adam Cuker, Eric K. Tseng, Robby Nieuwlaat, Pantep Angchaisuksiri, Clifton Blair, Kathryn Dane, Jennifer Davila, Maria T. DeSancho, David Diuguid, Daniel O. Griffin, Susan R. Kahn, Frederikus A. Klok, Alfred Ian Lee, Ignacio Neumann, Ashok Pai, Menaka Pai, Marc Righini, Kristen M. Sanfilippo, Deborah Siegal, Mike SkaraKamshad Touri, Elie A. Akl, Imad Bou Akl, Mary Boulos, Romina Brignardello-Petersen, Rana Charide, Matthew Chan, Karin Dearness, Andrea J. Darzi, Philipp Kolb, Luis E. Colunga-Lozano, Razan Mansour, Gian Paolo Morgano, Rami Z. Morsi, Atefeh Noori, Thomas Piggott, Yuan Qiu, Yetiani Roldan, Finn Schünemann, Adrienne Stevens, Karla Solo, Matthew Ventresca, Wojtek Wiercioch, Reem A. Mustafa, Holger J. Schünemann

Research output: Contribution to journalArticlepeer-review

73 Scopus citations

Abstract

Background: Coronavirus disease 2019 (COVID-19)-related critical illness and acute illness are associated with a 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 decisions about the use of anticoagulation for thromboprophylaxis for patients with COVID-19-related critical illness and acute illness who do not have confirmed or suspected VTE. Methods: ASH formed a multidisciplinary guideline panel and applied strict management strategies to minimize potential bias from conflicts of interest. The panel included 3 patient representatives. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic evidence reviews (up to 19 August 2020). 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, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 2 recommendations. The panel issued conditional recommendations in favor of prophylactic-intensity anticoagulation over intermediate-intensity or therapeutic-intensity anticoagulation for patients with COVID-19-related critical illness or acute illness who do not have confirmed or suspected VTE. Conclusions: These recommendations were based on very low certainty in the evidence, underscoring the need for high-quality, randomized controlled trials comparing different intensities of anticoagulation. They will be updated using a living recommendation approach as new evidence becomes available.

Original languageEnglish (US)
Pages (from-to)872-888
Number of pages17
JournalBlood Advances
Volume5
Issue number3
DOIs
StatePublished - Feb 9 2021

ASJC Scopus subject areas

  • Hematology

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