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

Author:

Cuker Adam1ORCID,Tseng Eric K.2ORCID,Nieuwlaat Robby3,Angchaisuksiri Pantep4,Blair Clifton5,Dane Kathryn6,Davila Jennifer7,DeSancho Maria T.8,Diuguid David9,Griffin Daniel O.1011ORCID,Kahn Susan R.12ORCID,Klok Frederikus A.13ORCID,Lee Alfred Ian14ORCID,Neumann Ignacio15,Pai Ashok16,Righini Marc17,Sanfilippo Kristen M.18ORCID,Siegal Deborah19ORCID,Skara Mike20,Terrell Deirdra R.21ORCID,Touri Kamshad22,Akl Elie A.23ORCID,Al Jabiri Reyad Nayif24,Al Jabiri Yazan Nayif25,Barbara Angela M.26,Bognanni Antonio3ORCID,Bou Akl Imad23,Boulos Mary27ORCID,Brignardello-Petersen Romina27ORCID,Charide Rana28ORCID,Chan Matthew29,Colunga-Lozano Luis E.30ORCID,Dearness Karin31ORCID,Darzi Andrea J.3ORCID,Hussein Heba32ORCID,Karam Samer G.3ORCID,Kolb Philipp33,Mansour Razan34ORCID,Morgano Gian Paolo3ORCID,Morsi Rami Z.35ORCID,Muti-Schünemann Giovanna3,Nadim Menatalla K.36ORCID,Noori Atefeh337ORCID,Philip Binu A.3,Piggott Thomas3ORCID,Qiu Yuan33ORCID,Benitez Yetiani Roldan3,Schünemann Finn38,Stevens Adrienne3ORCID,Solo Karla3ORCID,Wiercioch Wojtek3ORCID,Mustafa Reem A.339ORCID,Schünemann Holger J.340ORCID

Affiliation:

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

Abstract

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.

Publisher

American Society of Hematology

Subject

Hematology

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