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.

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.

• Authors: Adam Cuker, Eric K Tseng, Robby Nieuwlaat, Pantep Angchaisuksiri, Clifton Blair, Kathryn Dane, Jennifer Davila, Maria T DeSancho, David Diuguid, Daniel O Griffin, Susan R Kahn, Frederikus A Klok, Alfred Ian Lee, Ignacio Neumann, Ashok Pai, Marc Righini, Kristen M Sanfilippo, Deborah Siegal, Mike Skara, Deirdra R Terrell, Kamshad Touri, Elie A Akl, Imad Bou Akl, Antonio Bognanni, Mary Boulos, Romina Brignardello-Petersen, Rana Charide, Matthew Chan, Karin Dearness, Andrea J Darzi, Philipp Kolb, Luis E Colunga-Lozano, Razan Mansour, Gian Paolo Morgano, Rami Z Morsi, Giovanna Muti-Schünemann, Atefeh Noori, Binu A Philip, Thomas Piggott, Yuan Qiu, Yetiani Roldan, Finn Schünemann, Adrienne Stevens, Karla Solo, Wojtek Wiercioch, Reem A Mustafa, Holger J Schünemann
• Journal: Blood advances (Blood Adv) Vol. 5 Issue 20 Pg. 3951-3959 (10 26 2021) ISSN: 2473-9537 [Electronic] United States
• PMID: 34474482 (Publication Type: Journal Article, Practice Guideline, Research Support, N.I.H., Extramural)
• Copyright: © 2021 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.

Chemical References

• Anticoagulants

Topics

• Anticoagulants (adverse effects)
• COVID-19
• Critical Illness
• Evidence-Based Medicine
• Hematology
• Humans
• SARS-CoV-2
• United States
• Venous Thromboembolism (etiology, prevention & control)