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. 2022 Sep 13;6(17):4915-4923.
doi: 10.1182/bloodadvances.2022007561.

American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: January 2022 update on the use of therapeutic-intensity anticoagulation in acutely ill patients

Adam Cuker  1 , Eric K Tseng  2 , Robby Nieuwlaat  3 , Pantep Angchaisuksiri  4 , Clifton Blair  5 , Kathryn Dane  6 , Maria T DeSancho  7 , David Diuguid  8 , Daniel O Griffin  9   10   11 , Susan R Kahn  12 , Frederikus A Klok  13 , Alfred Ian Lee  14 , Ignacio Neumann  15 , Ashok Pai  16 , Marc Righini  17 , Kristen M Sanfilippo  18 , Deborah M Siegal  19 , Mike Skara  20 , Deirdra R Terrell  21 , Kamshad Touri  22 , Elie A Akl  23 , Reyad Al Jabiri  24 , Yazan Al Jabiri  25 , Angela M Barbara  3 , Antonio Bognanni  3 , Mary Boulos  3 , Romina Brignardello-Petersen  3 , Rana Charide  26 , Luis E Colunga-Lozano  27 , Karin Dearness  28 , Andrea J Darzi  3 , Heba Hussein  29 , Samer G Karam  3 , Razan Mansour  30 , Gian Paolo Morgano  3 , Rami Z Morsi  31 , Giovanna Muti-Schünemann  3 , Menatalla K Nadim  32 , Binu A Philip  3 , Yuan Qiu  3 , Yetiani Roldan Benitez  3 , Adrienne Stevens  3 , Karla Solo  3 , Wojtek Wiercioch  3 , Reem A Mustafa  3   33 , Holger J Schünemann  3   34
Affiliations

American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: January 2022 update on the use of therapeutic-intensity anticoagulation in acutely ill patients

Adam Cuker et al. Blood Adv. .

Update in

  • doi: 10.1182/bloodadvances.2020003763

Abstract

Background: COVID-19-related acute illness is associated with an increased risk of venous thromboembolism (VTE).

Objective: These evidence-based guidelines from the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in making decisions about the use of anticoagulation in patients with COVID-19.

Methods: ASH formed a multidisciplinary guideline panel that included patient representatives and applied strategies to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process and performed systematic evidence reviews (through November 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. This is an update to guidelines published in February 2021 as part of the living phase of these guidelines.

Results: The panel made one additional recommendation. The panel issued a conditional recommendation in favor of therapeutic-intensity over prophylactic-intensity anticoagulation in patients with COVID-19-related acute illness who do not have suspected or confirmed VTE. The panel emphasized the need for an individualized assessment of risk of thrombosis and bleeding. The panel also noted that heparin (unfractionated or low molecular weight) may be preferred because of a preponderance of evidence with this class of anticoagulants.

Conclusion: This conditional recommendation was based on very low certainty in the evidence, underscoring the need for additional, high-quality, randomized controlled trials comparing different intensities of anticoagulation in patients with COVID-19-related acute illness.

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Conflict of interest statement

Supplement 3 lists all members of the guideline panel, methods team, and systematic review team who contributed to this recommendation. Supplement 4 provides updated “Participant Information Forms” for all panel members that contain details on financial and nonfinancial interests, as well as the ASH conflict-of-interest policies agreed to by each individual. Supplement 5 provides the updated complete “Participant Information Forms” for researchers on the methods and systematic review teams who contributed to these guidelines.

Figures

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Graphical abstract
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References

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    1. Jiménez D, García-Sanchez A, Rali P, et al. . Incidence of VTE and bleeding among hospitalized patients with coronavirus disease 2019: a systematic review and meta-analysis. Chest. 2021;159(3):1182-1196. - PMC - PubMed
    1. Cuker A, Tseng EK, Nieuwlaat R, et al. . American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19. Blood Adv. 2021;5(3):872-888. - PMC - PubMed
    1. Institute of Medicine . Clinical Practice Guidelines We Can Trust. Washington, DC: National Academic Press; 2011.
    1. Schünemann HJ, Al-Ansary LA, Forland F, et al. ; Board of Trustees of the Guidelines International Network . Guidelines International Network: principles for disclosure of interests and management of conflicts in guidelines. Ann Intern Med. 2015;163(7):548-553. - PubMed

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