Siegal Deborah M, Tseng Eric K, Schünemann Holger J, Angchaisuksiri Pantep, Cuker Adam, Dane Kathryn, DeSancho Maria T, Diuguid David, Griffin Daniel O, Klok Frederikus A, Lee Alfred Ian, Neumann Ignacio, Pai Ashok, Righini Marc, Sanfilippo Kristen M, Terrell Deirdra R, Akl Elie A, Al Jabiri Reyad, Al Jabiri Yazan, Barbara Angela M, Bognanni Antonio, Akl Imad Bou, Boulos Mary, Brignardello-Petersen Romina, Chan Matthew, Charide Rana, Colunga-Lozano Luis E, Dearness Karin, Darzi Andrea J, Hussein Heba, Karam Samer G, Kolb Philipp, Mansour Razan, Morgano Gian Paolo, Morsi Rami Z, Muti-Schünemann Giovanna, Nadim Menatalla K, Noori Atefeh, Philip Binu A, Piggott Thomas, Qiu Yuan, Benitez Yetiani Roldan, Schünemann Finn, Stevens Adrienne, Solo Karla, Wiercioch Wojtek, Mustafa Reem A, Nieuwlaat Robby
Department of Medicine and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
Division of Hematology/Oncology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Blood Adv. 2025 Mar 25;9(6):1247-1260. doi: 10.1182/bloodadvances.2024014219.
COVID-19-related critical and acute illness is associated with an increased risk of venous thromboembolism (VTE). These evidence-based recommendations of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in decisions about using anticoagulation for thromboprophylaxis for patients with COVID-19-related critical illness; patients with COVID-19-related acute illness; and those being discharged from the hospital, who do not have suspected or confirmed VTE.
ASH formed a multidisciplinary panel, including patient representatives. The Michael G. DeGroote Cochrane Canada and MacGRADE Centres at McMaster University supported guideline development, including performing systematic reviews (up to June 2023). 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 to assess certainty in the evidence and make recommendations.
This is an executive summary of 3 updated recommendations that have been published, which concludes the living phase of the guidelines. For patients with COVID-19-related critical illness, the panel issued conditional recommendations suggesting (a) prophylactic-intensity over therapeutic-intensity anticoagulation and (b) prophylactic-intensity over intermediate-intensity anticoagulation. For patients with COVID-19-related acute illness, conditional recommendations were suggested (a) prophylactic-intensity over intermediate-intensity anticoagulation, and (b) therapeutic-intensity over prophylactic-intensity anticoagulation. The panel issued a conditional recommendation suggesting against the use of postdischarge anticoagulant thromboprophylaxis.
These conditional recommendations were made based on low or very low certainty in the evidence, underscoring the need for additional, high-quality, randomized controlled trials for patients with COVID-19.
与新型冠状病毒肺炎（COVID-19）相关的危重症和急性疾病与静脉血栓栓塞症（VTE）风险增加有关。美国血液学会（ASH）的这些循证建议旨在支持患者、临床医生和其他医疗保健专业人员，以便就COVID-19相关危重症患者、COVID-19相关急性疾病患者以及没有疑似或确诊VTE且即将出院的患者使用抗凝药物进行血栓预防的决策提供支持。
ASH成立了一个多学科小组，包括患者代表。加拿大麦克马斯特大学的迈克尔·G·德格罗特循证医学中心和麦克格雷德中心支持指南制定，包括进行系统评价（截至2023年6月）。该小组根据临床问题和结果对临床医生和患者的重要性进行优先排序。该小组采用推荐分级评估、制定和评价（GRADE）方法来评估证据的确定性并提出建议。
这是已发表的3项更新建议的执行摘要，标志着指南的现行阶段结束。对于COVID-19相关危重症患者，该小组发布了有条件建议，建议（a）预防性抗凝强度优于治疗性抗凝强度，以及（b）预防性抗凝强度优于中等强度抗凝。对于COVID-19相关急性疾病患者，提出了有条件建议（a）预防性抗凝强度优于中等强度抗凝，以及（b）治疗性抗凝强度优于预防性抗凝强度。该小组发布了一项有条件建议，反对出院后使用抗凝药物进行血栓预防。
这些有条件建议是基于证据的低确定性或极低确定性做出的，强调了对COVID-19患者进行更多高质量随机对照试验的必要性。
