Practice Guideline

. 2022 Jan 25;6(2):664-671.

doi: 10.1182/bloodadvances.2021005945.

American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: July 2021 update on postdischarge thromboprophylaxis

Adam Cuker¹, Eric K Tseng², Robby Nieuwlaat³, Pantep Angchaisuksiri⁴, Clifton Blair⁵, Kathryn Dane⁶, Jennifer Davila⁷, Maria T DeSancho⁸, David Diuguid⁹, Daniel O Griffin^{10

11}, Susan R Kahn¹², Frederikus A Klok¹³, Alfred Ian Lee¹⁴, Ignacio Neumann¹⁵, Ashok Pai¹⁶, Marc Righini¹⁷, Kristen M Sanfilippo¹⁸, Deborah Siegal¹⁹, Mike Skara²⁰, Deirdra R Terrell²¹, Kamshad Touri²², Elie A Akl²³, Reyad Nayif Al Jabiri²⁴, Yazan Nayif Al Jabiri²⁵, Angela M Barbara²⁶, Antonio Bognanni³, Imad Bou Akl²³, Mary Boulos²⁷, Romina Brignardello-Petersen²⁷, Rana Charide²⁸, Matthew Chan²⁹, Luis E Colunga-Lozano³⁰, Karin Dearness³¹, Andrea J Darzi³, Heba Hussein³², Samer G Karam³, Philipp Kolb³³, Razan Mansour³⁴, Gian Paolo Morgano³, Rami Z Morsi³⁵, Giovanna Muti-Schünemann³, Menatalla K Nadim³⁶, Atefeh Noori^{3

37}, Binu A Philip³, Thomas Piggott³, Yuan Qiu³³, Yetiani Roldan Benitez³, Finn Schünemann³⁸, Adrienne Stevens³, Karla Solo³, Wojtek Wiercioch³, Reem A Mustafa^{3

39}, Holger J Schünemann^{3

40}

Affiliations

¹ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
² Division of Hematology/Oncology; St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
³ Michael G. DeGroote Cochrane Canada and McGRADE Centre, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁴ Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
⁵ Union, NJ.
⁶ Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD.
⁷ Division of Pediatric Hematology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
⁸ Oncology, and Cellular Therapies, Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY.
⁹ Coagulation Service, Section of Hematology.
¹⁰ Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY.
¹¹ ProHealth NY, Lake Success, NY.
¹² Department of Medicine, McGill University, Montreal, QC, Canada.
¹³ Division of Thrombosis and Hemostasis, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands.
¹⁴ Section of Hematology, Yale School of Medicine, New Haven, CT.
¹⁵ Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
¹⁶ Division of Hematology and Oncology, Kaiser Permanente, Oakland/Richmond, CA.
¹⁷ Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
¹⁸ Division of Hematology, Washington University School of Medicine, St. Louis, MO.
¹⁹ Department of Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
²⁰ Cottage Grove, MN.
²¹ Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
²² Toronto, ON, Canada.
²³ Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
²⁴ Department of Medicine, University of Jordan, Amman, Jordan.
²⁵ Lincoln Medical Center, Bronx, NY.
²⁶ Department of Health Research Methods, Evidence, and Impact, Health Sciences Centre, McMaster University, Hamilton, ON, Canada.
²⁷ Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
²⁸ Clinical Research Institute, American University of Beirut, Beirut, Lebanon.
²⁹ Department of Medicine, McMaster University, Hamilton, ON, Canada.
³⁰ Department of Clinical Medicine, Health Science Center, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.
³¹ Library Services, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
³² Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt.
³³ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
³⁴ Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan.
³⁵ Department of Neurology, University of Chicago, Chicago, IL.
³⁶ Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
³⁷ The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, ON, Canada.
³⁸ Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany.
³⁹ Division of Nephrology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS.
⁴⁰ Institut für Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany.

PMID: 34727173
PMCID: PMC8566097
DOI: 10.1182/bloodadvances.2021005945

Practice Guideline

American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: July 2021 update on postdischarge thromboprophylaxis

Adam Cuker et al. Blood Adv. 2022.

. 2022 Jan 25;6(2):664-671.

doi: 10.1182/bloodadvances.2021005945.

Authors

Affiliations

¹ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
² Division of Hematology/Oncology; St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
³ Michael G. DeGroote Cochrane Canada and McGRADE Centre, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁴ Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
⁵ Union, NJ.
⁶ Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD.
⁷ Division of Pediatric Hematology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
⁸ Oncology, and Cellular Therapies, Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY.
⁹ Coagulation Service, Section of Hematology.
¹⁰ Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY.
¹¹ ProHealth NY, Lake Success, NY.
¹² Department of Medicine, McGill University, Montreal, QC, Canada.
¹³ Division of Thrombosis and Hemostasis, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands.
¹⁴ Section of Hematology, Yale School of Medicine, New Haven, CT.
¹⁵ Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
¹⁶ Division of Hematology and Oncology, Kaiser Permanente, Oakland/Richmond, CA.
¹⁷ Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
¹⁸ Division of Hematology, Washington University School of Medicine, St. Louis, MO.
¹⁹ Department of Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
²⁰ Cottage Grove, MN.
²¹ Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
²² Toronto, ON, Canada.
²³ Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
²⁴ Department of Medicine, University of Jordan, Amman, Jordan.
²⁵ Lincoln Medical Center, Bronx, NY.
²⁶ Department of Health Research Methods, Evidence, and Impact, Health Sciences Centre, McMaster University, Hamilton, ON, Canada.
²⁷ Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
²⁸ Clinical Research Institute, American University of Beirut, Beirut, Lebanon.
²⁹ Department of Medicine, McMaster University, Hamilton, ON, Canada.
³⁰ Department of Clinical Medicine, Health Science Center, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.
³¹ Library Services, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
³² Department of Oral Medicine and Periodontology, Faculty of Dentistry, Cairo University, Cairo, Egypt.
³³ Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
³⁴ Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan.
³⁵ Department of Neurology, University of Chicago, Chicago, IL.
³⁶ Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
³⁷ The Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, ON, Canada.
³⁸ Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany.
³⁹ Division of Nephrology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS.
⁴⁰ Institut für Evidence in Medicine, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany.

PMID: 34727173
PMCID: PMC8566097
DOI: 10.1182/bloodadvances.2021005945

Abstract

Background: COVID-19-related acute illness is associated with an increased 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 in patients with COVID-19 who do not have confirmed or suspected VTE.

Methods: 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.

Results: 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.

Conclusions: 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.

© 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.

PubMed Disclaimer

Figures

See this image and copyright information in PMC

References

1. Amin AN, Varker H, Princic N, Lin J, Thompson S, Johnston S. Duration of venous thromboembolism risk across a continuum in medically ill hospitalized patients. J Hosp Med. 2012;7(3):231-238. - PubMed
1. Amin A, Neuman WR, Lingohr-Smith M, Menges B, Lin J. Venous thromboembolism prophylaxis and risk in the inpatient and outpatient continuum of care among hospitalized acutely ill patients in the US: a retrospective analysis. Adv Ther. 2019;36(1):59-71. - PubMed
1. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020;135(23):2033-2040. - 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
1. Giannis D, Allen SL, Tsang J, et al. . Postdischarge thromboembolic outcomes and mortality of hospitalized patients with COVID-19: the CORE-19 registry. Blood. 2021;137(20):2838-2847. - PMC - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: July 2021 update on postdischarge thromboprophylaxis

Affiliations

American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: July 2021 update on postdischarge thromboprophylaxis

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous