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Blood Adv
. 2021 Feb 9;5(3):872-888.
doi: 10.1182/bloodadvances.2020003763.
American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19
Adam Cuker 1 , Eric K Tseng 2 , Robby Nieuwlaat 3 4 5 , Pantep Angchaisuksiri 6 , Clifton Blair 7 , Kathryn Dane 8 , Jennifer Davila 9 , Maria T DeSancho 10 , David Diuguid 11 , Daniel O Griffin 12 13 14 , Susan R Kahn 15 , Frederikus A Klok 16 , Alfred Ian Lee 17 , Ignacio Neumann 18 , Ashok Pai 19 , Menaka Pai 20 , Marc Righini 21 , Kristen M Sanfilippo 22 , Deborah Siegal 23 24 , Mike Skara 25 , Kamshad Touri 26 , Elie A Akl 27 , Imad Bou Akl 27 , Mary Boulos 28 , Romina Brignardello-Petersen 5 , Rana Charide 29 , Matthew Chan 20 , Karin Dearness 30 , Andrea J Darzi 3 4 5 , Philipp Kolb 28 , Luis E Colunga-Lozano 31 , Razan Mansour 32 , Gian Paolo Morgano 3 4 5 , Rami Z Morsi 33 , Atefeh Noori 3 4 5 34 , Thomas Piggott 5 , Yuan Qiu 28 , Yetiani Roldan 5 , Finn Sch?nemann 35 , Adrienne Stevens 3 4 5 , Karla Solo 3 4 5 , Matthew Ventresca 3 4 5 , Wojtek Wiercioch 3 4 5 , Reem A Mustafa 3 4 5 36 , Holger J Sch?nemann 3 4 5 20 37
Affiliations
- PMID: 33560401
- DOI: 10.1182/bloodadvances.2020003763
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.