Summary of the July 2021 Update of the ASH Living Guidelines on the use of anticoagulation for post-discharge thromboprophylaxis
| Recommendation: The ASH guideline panel suggests against using outpatient anticoagulant thromboprophylaxis in patients with COVID-19 who are being discharged from the hospital and who have suspected or confirmed VTE or another indication for anticoagulation (conditional recommendation based on very low certainty in the evidence about effects) |
| Remarks: An individualized assessment of the patient’s risk of thrombosis and bleeding and shared decision-making are important when deciding whether to use post-discharge thromboprophylaxis. Prospectively validated risk assessment models to estimate the risk of thrombosis and bleeding in patients with COVID-19 after they have been discharged from the hospital are not available. The panel acknowledged that post-discharge thromboprophylaxis may be reasonable in patients judged to be at high risk of thrombosis and low risk of bleeding. |
| Recommendation: The ASH guideline panel suggests against using outpatient anticoagulant thromboprophylaxis in patients with COVID-19 who are being discharged from the hospital and who have suspected or confirmed VTE or another indication for anticoagulation (conditional recommendation based on very low certainty in the evidence about effects) |
| Remarks: An individualized assessment of the patient’s risk of thrombosis and bleeding and shared decision-making are important when deciding whether to use post-discharge thromboprophylaxis. Prospectively validated risk assessment models to estimate the risk of thrombosis and bleeding in patients with COVID-19 after they have been discharged from the hospital are not available. The panel acknowledged that post-discharge thromboprophylaxis may be reasonable in patients judged to be at high risk of thrombosis and low risk of bleeding. |
The panel judged the benefits and hazards of post-discharge thromboprophylaxis to be trivial in terms of absolute effects. Even though there was a trivial mortality benefit (5 fewer deaths [from 7 fewer to 2 fewer deaths] per 1000 patients and reduction in VTE (4 fewer [from 9 fewer to 4 more]) per 1000 patients, this evidence was of very low certainty.1