American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19

Blood Advances - Tập 5 Số 3 - Trang 872-888 - 2021
Adam Cuker1, Eric Tseng2, Robby Nieuwlaat3,4,5, Pantep Angchaisuksiri6, Clifton Blair7, Kathryn Dane8, Jennifer Davila9, Maria T. DeSancho10, David Diuguid11, Daniel O. Griffin12,13,14, Susan R. Kahn15, Frederikus A. Klok16, Alfred Ian Lee17, Ignacio Neumann18, Ashok Pai19, Menaka Pai20, Marc Righini21, Kristen M. Sanfilippo22, Deborah M. Siegal23,24, Mike Skara25, Kamshad Touri26, Elie A. Akl27, Imad Bou Akl27, Mary Boulos28, Romina Brignardello‐Petersen3, Rana Charide29, Matthew T.V. Chan20, Karin Dearness30, Andrea Darzi3,4,5, Philipp Kolb28, Luis Enrique Colunga‐Lozano31, Razan Mansour32, Gian Paolo Morgano3,4,5, Rami Z. Morsi33, Atefeh Noori3,4,5,34, Thomas Piggott3, Yuan Qiu28, Yetiani Roldán3, Finn Schünemann35, Adrienne Stevens3,4,5, Karla Solo3,4,5, Matthew Ventresca3,4,5, Wojtek Wiercioch3,4,5, Reem A. Mustafa3,36,4,5, Holger J. Schünemann3,20,37,4,5
1Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
2St. Michael's Hospital, Division of Hematology/Oncology, University of Toronto, Toronto, ON, Canada
3Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
4McGRADE Centre, and
5Michael G. DeGroote Cochrane Canada Centre
6Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
7Union, NJ
8Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD
9Children's Hospital at Montefiore, Division of Pediatric Hematology, Oncology, and Cellular Therapies, Albert Einstein College of Medicine, Bronx, NY
10Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, NY;
11Department of Medicine, College of Physicians and Surgeons and
12Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY;
13Prohealth NY, Lake Success, NY
14Research and Development at United Health Group, Minnetonka, MN
15Department of Medicine, McGill University, Montreal, QC, Canada
16Thrombosis and Hemostasis, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands;
17Section of Hematology, School of Medicine, Yale University, New Haven, CT
18Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
19Division of Hematology and Oncology, Kaiser Permanente, Oakland/Richmond, CA
20Department of Medicine, McMaster University, Hamilton, ON, Canada
21Division of Angiology and Hemostasis, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
22Department of Medicine, Washington University School of Medicine St. Louis, St. Louis, MO
23Department of Medicine and
24Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
25Cottage Grove, MN
26Toronto, ON, Canada
27Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
28Michael G. DeGroote School of Medicine, McMaster University, Hamilton ON, Canada
29Clinical Research Institute, American University of Beirut, Beirut, Lebanon
30Library Services, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada;
31Department of Clinical Medicine, Health Science Center, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico;
32Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
33Department of Neurology, University of Chicago, Chicago, IL;
34The Michael G. DeGroote National Pain Center, McMaster University, Hamilton, ON, Canada;
35Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany
36Department of Internal Medicine, Division of Nephrology, University of Kansas Medical Center, Kansas City, KS; and
37Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany

Tóm tắt

Background:Coronavirus disease 2019 (COVID-19)–related critical illness and acute illness are associated with a 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 for patients with COVID-19–related critical illness and acute illness who do not have confirmed or suspected VTE.Methods:ASH formed a multidisciplinary guideline panel and applied strict management strategies to minimize potential bias from conflicts of interest. The panel included 3 patient representatives. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic evidence reviews (up to 19 August 2020). 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, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment.Results:The panel agreed on 2 recommendations. The panel issued conditional recommendations in favor of prophylactic-intensity anticoagulation over intermediate-intensity or therapeutic-intensity anticoagulation for patients with COVID-19–related critical illness or acute illness who do not have confirmed or suspected VTE.Conclusions:These recommendations were based on very low certainty in the evidence, underscoring the need for high-quality, randomized controlled trials comparing different intensities of anticoagulation. They will be updated using a living recommendation approach as new evidence becomes available.

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