The ASH Choosing Wisely List
Developed as part of Choosing Wisely®, an initiative of the ABIM Foundation, the ASH Choosing Wisely list provides 10 evidence-based recommendations in an effort to prompt conversations between patients and physicians about the necessity and potential harm of certain practices. The first five recommendations were released in 2013 and highlighted in a manuscript published in Blood after months of careful data analysis and review, as well as input from the Society's membership, using the most current evidence about management and treatment options. The list was recently updated to include five additional commonly used tests, treatments, and procedures in hematology that physicians and patients should question in certain circumstances. These new practices to question are highlighted in a new manuscript published in Blood in December 2014, which further describes the methods in development of the list and the evidentiary basis of the recommendations.
- Do not transfuse more than the minimum number of red blood cell (RBC) units necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range (7 to 8 g/dL in stable, non-cardiac, in-patients).
- Don't test for thrombophilia in adult patients with venous thromboembolism (VTE) occurring in the setting of major transient risk factors (surgery, trauma or prolonged immobility).
- Don't use inferior vena cava (IVC) filters routinely in patients with acute venous thromboembolism (VTE).
- Don't administer plasma or prothrombin complex concentrates for non-emergent reversal of vitamin K antagonists (i.e. outside of the setting of major bleeding, intracranial hemorrhage or anticipated emergent surgery).
- Limit surveillance computed tomography (CT) scans in asymptomatic patients following curative-intent treatment for aggressive lymphoma.
- Don't treat with an anticoagulant for more than three months in a patient with a first venous thromboembolism occurring in the setting of a major transient risk factor.
- Don’t routinely transfuse patients with sickle cell disease for chronic anemia or uncomplicated pain crisis without an appropriate clinical indication.
- Don’t perform baseline or routine surveillance computed tomography (CT) scans in patients with asymptomatic, early stage chronic lymphocytic leukemia.
- Don’t test or treat for suspected heparin-induced thrombocytopenia (HIT) in patients with a low pre-test probability of HIT.
- Don’t treat patients with immune thrombocytopenic purpura in the absence of bleeding or a very low platelet count.
Choosing Wisely® is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources. Participating specialty societies are working with the ABIM Foundation and Consumer Reports to share the lists widely with their members and convene discussions about the physician's role in helping patients make wise choices. Learn more at www.ChoosingWisely.org.
Additional Presentation Materials
In support of the Choosing Wisely initiative, the ASH Choosing Wisely Task Force has produced an educational presentation to serve as a companion to the ASH Choosing Wisely list. The presentation describes in detail how the list was created and the underlying evidence supporting the recommendations. The presentation can be downloaded as a PowerPoint slide deck or a PDF document for printing. Members are encouraged to use the presentation and to share it among colleagues.
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