American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: May 2021 update on the use of intermediate-intensity anticoagulation in critically ill patients

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.101112ORCID,Kahn Susan R.13,Klok Frederikus A.14ORCID,Lee Alfred Ian15,Neumann Ignacio16,Pai Ashok17,Righini Marc18,Sanfilippo Kristen M.19ORCID,Siegal Deborah20ORCID,Skara Mike21,Terrell Deirdra R.22ORCID,Touri Kamshad23,Akl Elie A.24ORCID,Bou Akl Imad24,Bognanni Antonio3ORCID,Boulos Mary25ORCID,Brignardello-Petersen Romina3ORCID,Charide Rana26,Chan Matthew27,Dearness Karin28ORCID,Darzi Andrea J.3ORCID,Kolb Philipp25,Colunga-Lozano Luis E.29ORCID,Mansour Razan30ORCID,Morgano Gian Paolo3ORCID,Morsi Rami Z.31ORCID,Muti-Schünemann Giovanna3,Noori Atefeh332ORCID,Philip Binu A.3,Piggott Thomas3ORCID,Qiu Yuan25ORCID,Roldan Yetiani3,Schünemann Finn33,Stevens Adrienne3ORCID,Solo Karla3ORCID,Wiercioch Wojtek3ORCID,Mustafa Reem A.334ORCID,Schünemann Holger J.335ORCID

Affiliation:

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, 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. Children’s Hospital at Montefiore, Division of Pediatric Hematology, Oncology, and Cellular Therapies, Albert Einstein College of Medicine, Bronx, NY;

8. Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY;

9. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY;

10. Department of Medicine, Division of Infectious Diseases, College of Physicians and Surgeons, Columbia University, New York, NY;

11. Research and Development at United Health Group, Minnetonka, MN;

12. Prohealth NY, Lake Success, NY;

13. Department of Medicine, McGill University, Montreal, QC, Canada;

14. Department of Internal Medicine–Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands;

15. Section of Hematology, School of Medicine, Yale University, New Haven, CT;

16. Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile;

17. Division of Hematology and Oncology, Kaiser Permanente, Oakland/Richmond, CA;

18. Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland;

19. Department of Medicine, Washington University School of Medicine St. Louis, St. Louis, MO;

20. Department of Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada;

21. Cottage Grove, MN;

22. Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK;

23. Toronto, ON, Canada;

24. Department of Internal Medicine, American University of Beirut, Beirut, Lebanon;

25. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada;

26. Clinical Research Institute, American University of Beirut, Beirut, Lebanon;

27. Department of Medicine, McMaster University, Hamilton, ON, Canada;

28. Library Services, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada;

29. Department of Clinical Medicine, Health Science Center, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico;

30. Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan;

31. Department of Neurology, University of Chicago, Chicago, IL;

32. The Michael G. DeGroote National Pain Center, McMaster University, Hamilton, ON, Canada;

33. Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany;

34. Department of Internal Medicine, Division of Nephrology, University of Kansas Medical Center, KS; and

35. Institute for Evidence in Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany

Abstract

Abstract Background: COVID-19–related critical 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 making decisions about the use of anticoagulation for thromboprophylaxis in patients with COVID-19–related critical illness who do not have confirmed or suspected VTE. Methods: ASH formed a multidisciplinary guideline panel that included 3 patient representatives and applied strategies to minimize potential bias from conflicts of interest. The McMaster University Grading of Recommendations Assessment, Development and Evaluation (GRADE) Centre supported the guideline development process by performing systematic evidence reviews (up to 5 March 2021). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the GRADE approach to assess evidence and make recommendations, which were subject to public comment. This is an update on guidelines published in February 2021. Results: The panel agreed on 1 additional recommendation. The panel issued a conditional recommendation in favor of prophylactic-intensity over intermediate-intensity anticoagulation in patients with COVID-19–related critical illness who do not have confirmed or suspected VTE. Conclusions: This recommendation was based on low certainty in the evidence, which underscores the need for additional high-quality, randomized, controlled trials comparing different intensities of anticoagulation in critically ill patients. Other key research priorities include better evidence regarding predictors of thrombosis and bleeding risk in critically ill patients with COVID-19 and the impact of nonanticoagulant therapies (eg, antiviral agents, corticosteroids) on thrombotic risk.

Publisher

American Society of Hematology

Subject

Hematology

Reference62 articles.

1. COVID-19 and its implications for thrombosis and anticoagulation;Connors;Blood.,2020

2. Risk of venous thromboembolism in patients with COVID-19: A systematic review and meta-analysis;Nopp;Res Pract Thromb Haemost.,2020

3. Prophylactic anticoagulants for people hospitalised with COVID-19;Flumignan;Cochrane Database Syst Rev.,2020

4. The unique characteristics of COVID-19 coagulopathy;Iba;Crit Care.,2020

5. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection;Al-Samkari;Blood.,2020

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