. 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 Cuker¹, Eric K Tseng², Robby Nieuwlaat^{3

4

5}, Pantep Angchaisuksiri⁶, Clifton Blair⁷, Kathryn Dane⁸, Jennifer Davila⁹, Maria T DeSancho¹⁰, David Diuguid¹¹, Daniel O Griffin^{12

13

14}, Susan R Kahn¹⁵, Frederikus A Klok¹⁶, Alfred Ian Lee¹⁷, Ignacio Neumann¹⁸, Ashok Pai¹⁹, Menaka Pai²⁰, Marc Righini²¹, Kristen M Sanfilippo²², Deborah Siegal^{23

24}, Mike Skara²⁵, Kamshad Touri²⁶, Elie A Akl²⁷, Imad Bou Akl²⁷, Mary Boulos²⁸, Romina Brignardello-Petersen⁵, Rana Charide²⁹, Matthew Chan²⁰, Karin Dearness³⁰, Andrea J Darzi^{3

4

5}, Philipp Kolb²⁸, Luis E Colunga-Lozano³¹, Razan Mansour³², Gian Paolo Morgano^{3

4

5}, Rami Z Morsi³³, Atefeh Noori^{3

4

5

34}, Thomas Piggott⁵, Yuan Qiu²⁸, Yetiani Roldan⁵, Finn Schünemann³⁵, 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 Schünemann^{3

4

5

20

37}

Affiliations

¹ Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
² St. Michael's Hospital, Division of Hematology/Oncology, University of Toronto, Toronto, ON, Canada.
³ Michael G. DeGroote Cochrane Canada Centre.
⁴ McGRADE Centre, and.
⁵ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁶ Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
⁷ Union, NJ.
⁸ Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD.
⁹ Children's Hospital at Montefiore, Division of Pediatric Hematology, Oncology, and Cellular Therapies, Albert Einstein College of Medicine, Bronx, NY.
¹⁰ Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY.
¹¹ Department of Medicine, College of Physicians and Surgeons and.
¹² Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY.
¹³ Research and Development at United Health Group, Minnetonka, MN.
¹⁴ Prohealth NY, Lake Success, NY.
¹⁵ Department of Medicine, McGill University, Montreal, QC, Canada.
¹⁶ Thrombosis and Hemostasis, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands.
¹⁷ Section of Hematology, School of Medicine, Yale University, New Haven, CT.
¹⁸ Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
¹⁹ Division of Hematology and Oncology, Kaiser Permanente, Oakland/Richmond, CA.
²⁰ Department of Medicine, McMaster University, Hamilton, ON, Canada.
²¹ Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
²² Department of Medicine, Washington University School of Medicine St. Louis, St. Louis, MO.
²³ Department of Medicine and.
²⁴ Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
²⁵ Cottage Grove, MN.
²⁶ Toronto, ON, Canada.
²⁷ Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
²⁸ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
²⁹ Clinical Research Institute, American University of Beirut, Beirut, Lebanon.
³⁰ Library Services, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
³¹ Department of Clinical Medicine, Health Science Center, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.
³² Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan.
³³ Department of Neurology, University of Chicago, Chicago, IL.
³⁴ The Michael G. DeGroote National Pain Center, McMaster University, Hamilton, ON, Canada.
³⁵ Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany.
³⁶ Department of Internal Medicine, Division of Nephrology, University of Kansas Medical Center, Kansas City, KS; and.
³⁷ Institute for Evidence in Medicine, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany.

PMID: 33560401
PMCID: PMC7869684
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 et al. Blood Adv. 2021.

. 2021 Feb 9;5(3):872-888.

doi: 10.1182/bloodadvances.2020003763.

Authors

Affiliations

¹ Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
² St. Michael's Hospital, Division of Hematology/Oncology, University of Toronto, Toronto, ON, Canada.
³ Michael G. DeGroote Cochrane Canada Centre.
⁴ McGRADE Centre, and.
⁵ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁶ Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
⁷ Union, NJ.
⁸ Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD.
⁹ Children's Hospital at Montefiore, Division of Pediatric Hematology, Oncology, and Cellular Therapies, Albert Einstein College of Medicine, Bronx, NY.
¹⁰ Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY.
¹¹ Department of Medicine, College of Physicians and Surgeons and.
¹² Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY.
¹³ Research and Development at United Health Group, Minnetonka, MN.
¹⁴ Prohealth NY, Lake Success, NY.
¹⁵ Department of Medicine, McGill University, Montreal, QC, Canada.
¹⁶ Thrombosis and Hemostasis, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands.
¹⁷ Section of Hematology, School of Medicine, Yale University, New Haven, CT.
¹⁸ Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
¹⁹ Division of Hematology and Oncology, Kaiser Permanente, Oakland/Richmond, CA.
²⁰ Department of Medicine, McMaster University, Hamilton, ON, Canada.
²¹ Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
²² Department of Medicine, Washington University School of Medicine St. Louis, St. Louis, MO.
²³ Department of Medicine and.
²⁴ Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
²⁵ Cottage Grove, MN.
²⁶ Toronto, ON, Canada.
²⁷ Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
²⁸ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
²⁹ Clinical Research Institute, American University of Beirut, Beirut, Lebanon.
³⁰ Library Services, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
³¹ Department of Clinical Medicine, Health Science Center, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.
³² Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan.
³³ Department of Neurology, University of Chicago, Chicago, IL.
³⁴ The Michael G. DeGroote National Pain Center, McMaster University, Hamilton, ON, Canada.
³⁵ Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany.
³⁶ Department of Internal Medicine, Division of Nephrology, University of Kansas Medical Center, Kansas City, KS; and.
³⁷ Institute for Evidence in Medicine, Medical Center/Faculty of Medicine, University of Freiburg, Freiburg, Germany.

PMID: 33560401
PMCID: PMC7869684
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.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest disclosure: All authors were members of the guideline panel or members of the systematic review team or both. As such, they completed a disclosure-of-interest form, which was reviewed by ASH and is available as supplemental Files 4 and 5.

Figures

See this image and copyright information in PMC

Comment in

Sustained High D-Dimer in Outpatients Who Have Recovered from Mild to Moderate Coronavirus Disease 2019 (COVID-19).
Fazio S, Tufano A, de Simone G. Fazio S, et al. Semin Thromb Hemost. 2022 Feb;48(1):115-117. doi: 10.1055/s-0041-1729857. Epub 2021 May 7. Semin Thromb Hemost. 2022. PMID: 33962473 No abstract available.

References

1. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020;135(23):2033-2040. - PMC - PubMed
1. Zhou F, Yu T, Du R, et al. . Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. - PMC - PubMed
1. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-847. - PMC - PubMed
1. Guan WJ, Ni ZY, Hu Y, et al. ; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. - PMC - PubMed
1. Nopp S, Moik F, Jilma B, Pabinger I, Ay C. Risk of venous thromboembolism in patients with COVID-19: a systematic review and meta-analysis. Res Pract Thromb Haemost. 2020;4(7):1178-1191. - PMC - PubMed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Miscellaneous