COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Treatment Cuker A, Tseng EK, Nieuwlaat R, et al. American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19. Blood Adv. 2021 Feb 9;5(3):872-888. doi: 10.1182/bloodadvances.2020003763.
Abstract

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.

Ratings
Discipline / Specialty Area Score
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
Hemostasis and Thrombosis
Intensivist/Critical Care
Respirology/Pulmonology
Comments from MORE raters

Hemostasis and Thrombosis rater

This mult-authored work is somewhat confusing. SARS-Cov2 Disease needs the best hemostasis activation diagnosis and therapy (Destruction of Monocytes/Macrophages by Corona Virus Might Explain Peri-Alveolar and Systemic Micro-Thrombi. ES J Microbiol. 2020; 1(1): 1005.). The central question is: what is the activity of circulating thrombin and how can it be lowered to less than 120% of norm. Probably the most physiologic anticoagulant (and profibrinolytic) is low molecular weight heparin. The anticoagulant action of any plasmatic anticoagulant is monitored by new thrombin generation assays (e.g. EXCA or INCA).

Intensivist/Critical Care rater

Unfortunately, there are only limited data available in this area. However, this guideline is an important up-to-date statement about anticoagulation in COVID-19.