Recommendation
| Recommendation . | Remarks . |
|---|---|
| Recommendation 2b. The ASH guideline panel suggests using therapeutic-intensity over prophylactic-intensity anticoagulation for patients with COVID-19–related acute illness who do not have suspected or confirmed VTE or another indication for anticoagulation certainty (conditional recommendation based on very low certainty in the evidence about effects ⨁◯◯◯). | • Patients with COVID-19–related acute illness are defined as those with clinical features that would typically result in admission to an inpatient medical ward without requirement for intensive clinical support. Examples include patients with dyspnea or mild-to-moderate hypoxia. • An individualized assessment of the patient’s risk of thrombosis and bleeding is important when deciding on anticoagulation intensity. Risk assessment models for estimating risk of thrombosis in hospitalized patients have been validated in patients with COVID-19, with modest prognostic performance. No risk assessment models f or bleeding have been validated in patients with COVID-19. The panel acknowledges that lower-intensity anticoagulation may be preferred for patients judged to be at high risk of bleeding and low risk of thrombosis. • At present, there is no direct high-certainty evidence comparing different types of anticoagulants in patients with COVID-19. Unfractionated or low molecular weight heparin may be preferred because of a preponderance of evidence with these agents. There are no studies of therapeutic-intensity fondaparinux, argatroban, or bivalirudin in this population. |
| Recommendation . | Remarks . |
|---|---|
| Recommendation 2b. The ASH guideline panel suggests using therapeutic-intensity over prophylactic-intensity anticoagulation for patients with COVID-19–related acute illness who do not have suspected or confirmed VTE or another indication for anticoagulation certainty (conditional recommendation based on very low certainty in the evidence about effects ⨁◯◯◯). | • Patients with COVID-19–related acute illness are defined as those with clinical features that would typically result in admission to an inpatient medical ward without requirement for intensive clinical support. Examples include patients with dyspnea or mild-to-moderate hypoxia. • An individualized assessment of the patient’s risk of thrombosis and bleeding is important when deciding on anticoagulation intensity. Risk assessment models for estimating risk of thrombosis in hospitalized patients have been validated in patients with COVID-19, with modest prognostic performance. No risk assessment models f or bleeding have been validated in patients with COVID-19. The panel acknowledges that lower-intensity anticoagulation may be preferred for patients judged to be at high risk of bleeding and low risk of thrombosis. • At present, there is no direct high-certainty evidence comparing different types of anticoagulants in patients with COVID-19. Unfractionated or low molecular weight heparin may be preferred because of a preponderance of evidence with these agents. There are no studies of therapeutic-intensity fondaparinux, argatroban, or bivalirudin in this population. |