Coagulation

Preventive anticoagulation in COVID-19 should be given at a standard dose: ASH


Clinicians should use a standard prophylactic anticoagulant dose over higher doses to prevent clotting in patients who have been hospitalised with COVID-19, including those in intensive care, according to new guidelines from the American Society of Hematology.

The guidelines, which address both critically and acutely ill hospitalised patients, were put together by a multidisciplinary, internationally representative panel who examined all available evidence, including early reports from observational studies.

The panel concluded that the use of higher doses of anticoagulants was not recommended, as the greater risk for serious bleeding may outweigh the potential benefits.

However, they noted the importance of individualised 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.

Over the next couple of months the 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,” ASH stated.

Meanwhile, ASH also issued new guidelines this week on managing venous thromboembolism.

Published in Blood Advances, three out of the 28 recommendations were classified by the guidelines committee as ‘strong’.

These included: For patients with pulmonary embolism (PE) and hemodynamic compromise, thrombolytic therapy followed by anticoagulation is recommended over anticoagulation alone.

  • For those with deep venous thrombosis (DVT) or PE who have finished primary treatment and will continue a vitamin K antagonist for secondary prevention, an INR range of 2.0–3.0 should be used rather than a lower range.

  • For patients with recurrent unprovoked DVT or PE, continuing antithrombotic therapy indefinitely is advised rather than stopping anticoagulation after primary treatment.

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