American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: July 2021 update on postdischarge thromboprophylaxis
COVID-19–related acute illness is associated with an increased risk of venous thromboembolism (VTE). 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 anticoagula...
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| Published in | Blood advances Vol. 6; no. 2; pp. 664 - 671 |
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| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Elsevier Inc
25.01.2022
American Society of Hematology |
| Subjects | |
| Online Access | Get full text |
| ISSN | 2473-9529 2473-9537 2473-9537 |
| DOI | 10.1182/bloodadvances.2021005945 |
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| Abstract | COVID-19–related acute illness is associated with an increased risk of venous thromboembolism (VTE).
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 in patients with COVID-19 who do not have confirmed or suspected VTE.
ASH formed a multidisciplinary guideline panel, including 3 patient representatives, and applied strategies to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including performing systematic evidence reviews (up to March 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.
The panel agreed on 1 additional recommendation. The panel issued a conditional recommendation against the use of outpatient anticoagulant prophylaxis in patients with COVID-19 who are discharged from the hospital and who do not have suspected or confirmed VTE or another indication for anticoagulation.
This recommendation was based on very low certainty in the evidence, underscoring the need for high-quality randomized controlled trials assessing the role of postdischarge thromboprophylaxis. Other key research priorities include better evidence on assessing risk of thrombosis and bleeding outcomes in patients with COVID-19 after hospital discharge.
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| AbstractList | COVID-19–related acute illness is associated with an increased risk of venous thromboembolism (VTE).
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 in patients with COVID-19 who do not have confirmed or suspected VTE.
ASH formed a multidisciplinary guideline panel, including 3 patient representatives, and applied strategies to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including performing systematic evidence reviews (up to March 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.
The panel agreed on 1 additional recommendation. The panel issued a conditional recommendation against the use of outpatient anticoagulant prophylaxis in patients with COVID-19 who are discharged from the hospital and who do not have suspected or confirmed VTE or another indication for anticoagulation.
This recommendation was based on very low certainty in the evidence, underscoring the need for high-quality randomized controlled trials assessing the role of postdischarge thromboprophylaxis. Other key research priorities include better evidence on assessing risk of thrombosis and bleeding outcomes in patients with COVID-19 after hospital discharge.
[Display omitted] COVID-19-related acute illness is associated with an increased risk of venous thromboembolism (VTE). 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 in patients with COVID-19 who do not have confirmed or suspected VTE. ASH formed a multidisciplinary guideline panel, including 3 patient representatives, and applied strategies to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including performing systematic evidence reviews (up to March 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. The panel agreed on 1 additional recommendation. The panel issued a conditional recommendation against the use of outpatient anticoagulant prophylaxis in patients with COVID-19 who are discharged from the hospital and who do not have suspected or confirmed VTE or another indication for anticoagulation. This recommendation was based on very low certainty in the evidence, underscoring the need for high-quality randomized controlled trials assessing the role of postdischarge thromboprophylaxis. Other key research priorities include better evidence on assessing risk of thrombosis and bleeding outcomes in patients with COVID-19 after hospital discharge. COVID-19-related acute illness is associated with an increased risk of venous thromboembolism (VTE).BACKGROUNDCOVID-19-related acute illness is associated with an increased risk of venous thromboembolism (VTE).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 in patients with COVID-19 who do not have confirmed or suspected VTE.OBJECTIVEThese 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 in patients with COVID-19 who do not have confirmed or suspected VTE.ASH formed a multidisciplinary guideline panel, including 3 patient representatives, and applied strategies to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including performing systematic evidence reviews (up to March 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.METHODSASH formed a multidisciplinary guideline panel, including 3 patient representatives, and applied strategies to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including performing systematic evidence reviews (up to March 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.The panel agreed on 1 additional recommendation. The panel issued a conditional recommendation against the use of outpatient anticoagulant prophylaxis in patients with COVID-19 who are discharged from the hospital and who do not have suspected or confirmed VTE or another indication for anticoagulation.RESULTSThe panel agreed on 1 additional recommendation. The panel issued a conditional recommendation against the use of outpatient anticoagulant prophylaxis in patients with COVID-19 who are discharged from the hospital and who do not have suspected or confirmed VTE or another indication for anticoagulation.This recommendation was based on very low certainty in the evidence, underscoring the need for high-quality randomized controlled trials assessing the role of postdischarge thromboprophylaxis. Other key research priorities include better evidence on assessing risk of thrombosis and bleeding outcomes in patients with COVID-19 after hospital discharge.CONCLUSIONSThis recommendation was based on very low certainty in the evidence, underscoring the need for high-quality randomized controlled trials assessing the role of postdischarge thromboprophylaxis. Other key research priorities include better evidence on assessing risk of thrombosis and bleeding outcomes in patients with COVID-19 after hospital discharge. |
| Author | Muti-Schünemann, Giovanna Piggott, Thomas Schünemann, Finn Dane, Kathryn Stevens, Adrienne Charide, Rana Klok, Frederikus A. Wiercioch, Wojtek Lee, Alfred Ian Tseng, Eric K. Barbara, Angela M. Davila, Jennifer Nadim, Menatalla K. Karam, Samer G. Solo, Karla Skara, Mike Righini, Marc Terrell, Deirdra R. Benitez, Yetiani Roldan Blair, Clifton Hussein, Heba Brignardello-Petersen, Romina Kolb, Philipp Chan, Matthew Siegal, Deborah Al Jabiri, Yazan Nayif DeSancho, Maria T. Nieuwlaat, Robby Al Jabiri, Reyad Nayif Mustafa, Reem A. Sanfilippo, Kristen M. Diuguid, David Dearness, Karin Darzi, Andrea J. Philip, Binu A. Schünemann, Holger J. Bou Akl, Imad Angchaisuksiri, Pantep Morgano, Gian Paolo Mansour, Razan Boulos, Mary Qiu, Yuan Neumann, Ignacio Griffin, Daniel O. Noori, Atefeh Kahn, Susan R. Akl, Elie A. Colunga-Lozano, Luis E. Cuker, Adam Pai, Ashok Morsi, Rami Z. Bognanni, Antonio Touri, Kamshad |
| AuthorAffiliation | 32 Department of Clinical Medicine, Health Science Center, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico 6 Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD 36 Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan 5 Union, NJ 8 Oncology, and Cellular Therapies, Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY 21 Cottage Grove, MN 12 ProHealth NY, Lake Success, NY 33 Library Services, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada 38 Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt 13 Department of Medicine, McGill University, Montreal, QC, Canada 15 Section of Hematology, Yale School of Medicine, New Haven, CT 24 Department of Internal Medicine, American University of Beirut, Beirut, Lebanon 41 Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany 17 Division of Hematology and Oncology, Kaiser |
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| Author_xml | – sequence: 1 givenname: Adam orcidid: 0000-0002-3595-5697 surname: Cuker fullname: Cuker, Adam email: adam.cuker@pennmedicine.upenn.edu organization: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA – sequence: 2 givenname: Eric K. orcidid: 0000-0003-2745-8057 surname: Tseng fullname: Tseng, Eric K. organization: Division of Hematology/Oncology; St. Michael's Hospital, University of Toronto, Toronto, ON, Canada – sequence: 3 givenname: Robby surname: Nieuwlaat fullname: Nieuwlaat, Robby organization: Michael G. 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DeGroote Cochrane Canada and McGRADE Centre, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/34727173$$D View this record in MEDLINE/PubMed |
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These evidence-based guidelines of the American Society of... COVID-19-related acute illness is associated with an increased risk of venous thromboembolism (VTE). These evidence-based guidelines of the American Society of... COVID-19-related acute illness is associated with an increased risk of venous thromboembolism (VTE).BACKGROUNDCOVID-19-related acute illness is associated with... |
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| SubjectTerms | Aftercare Anticoagulants - adverse effects Clinical Guidelines COVID-19 Evidence-Based Medicine Hematology Humans Patient Discharge SARS-CoV-2 United States Venous Thromboembolism - etiology Venous Thromboembolism - prevention & control |
| Title | American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: July 2021 update on postdischarge thromboprophylaxis |
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