ASH Releases Clinical Practice Guidelines on the Use of Preventive Anticoagulation in Patients with COVID-19
Evidence-based recommendations will inform prevention of COVID-related blood clotting
(WASHINGTON, Oct. 8, 2020) — Today, ASH released new guidelines to help clinicians prevent serious blood clotting complications affecting COVID-19 patients. The recommendations suggest that clinicians should use a standard prophylactic anticoagulant dose over higher doses to prevent clotting in patients who have been hospitalized with COVID-19, including those in intensive care.
Abnormal blood clotting has been reported as a complication associated with increased risk of death in patients with COVID-19, particularly hospitalized patients. The guidelines address both critically ill hospitalized patients – people who are ill enough to require intensive care – and acutely ill hospitalized patients – people who require monitoring and treatment in the hospital but not intensive care. It is common for clinicians to administer anticoagulants to these patients upon admission to try to prevent formation of blood clots; however, there is uncertainty regarding the right dose to give. For both acutely and critically ill patients, the guidelines suggest the use of a standard prophylactic dose of anticoagulation upon admission to the hospital. The use of higher doses of anticoagulants is not recommended, as it may pose greater risk for serious bleeding that outweighs potential benefits. However, the guideline panel highlighted the importance of individualized decision-making and acknowledged that a higher dose of anticoagulants may be appropriate in patients judged to be at especially high clotting risk and low bleeding risk.
“COVID-19 is the most important public health problem of our lifetime, with more than one million deaths worldwide. Data suggest that abnormal blood clotting plays an important role in why patients die or get very sick from this disease. Thus, it is important that these patients be given anticoagulants to try to prevent clots, and data available right now suggest that standard dosing provides the best balance of benefits and risks,” said ASH President Stephanie Lee, MD, of Fred Hutchinson Cancer Research Center. “Equipping clinicians with evidence-based guidelines that focus on the prevention of clotting has the potential to save lives.”
In June 2020, ASH formed a multidisciplinary, internationally representative panel to develop the guidelines. The panel was chaired by Drs. Adam Cuker, of the University of Pennsylvania; Holger Schunemann, of McMaster University; and Reem Mustafa, of University of Kansas Medical Center. The panel urgently examined all available evidence, including early reports from observational studies. Development of these guidelines, including systematic evidence review, was supported by the McMaster University GRADE Centre, a world leader in guideline development. At this time, the best available evidence is very low quality, and the recommendations are framed with conditions, explanations, and a call for more research. The systematic reviews and recommendations will continue to be maintained and updated, especially as better evidence from randomized clinical trials becomes available.
“The development of these guidelines was driven by the critical need to address serious and life-threatening blood clotting from COVID-19,” said Adam Cuker, MD, co-chair of the guideline panel and Associate Professor of Medicine at the University of Pennsylvania. “Hematologists are experts at treating blood clotting, and ASH has extensive experience with guideline development. These recommendations will continue to be updated to help shape front-line COVID-19 treatment.”
During October and November, these recommendations and a report of the guideline development process will undergo public review and ASH organizational review and approval. Ultimately, the guidelines will be submitted for publication in Blood Advances. The evidence supporting these guidelines will be maintained through living systematic reviews and updated as needed.
- New Guidelines on Use of Anticoagulation in COVID-19 Patients
- Webinar about Guidelines on Use of Anticoagulation in COVID-19 Patients
- ASH COVID-19 Resources and FAQs for Clinicians
- ASH Clinical Practice Guidelines on Venous Thromboembolism
The American Society of Hematology (ASH) is the world’s largest professional society of hematologists dedicated to furthering the understanding, diagnosis, treatment, and prevention of disorders affecting the blood. For more than 60 years, the Society has led the development of hematology as a discipline by promoting research, patient care, education, training, and advocacy in hematology. ASH publishes Blood (www.bloodjournal.org), the most cited peer-reviewed publication in the field, and Blood Advances (www.bloodadvances.org), an online, peer-reviewed open access journal. www.hematology.org
Leah Enser, American Society of Hematology