AASH Guidelines Advise Standard Prophylactic Anticoagulant Doses for COVID-19

Standard prophylactic doses of anticoagulants are advised for most COVID-19 patients, according to new guidance from the American Society of Hematology. Find out what else the specialty society recommends for novel coronavirus patients, who face a higher risk of death from abnormal blood clotting.

WASHINGTON, DC – Abnormal blood clotting has been linked to a higher risk of death in patients with COVID-19, especially those sick enough to be hospitalized. What has been unclear, however, is how anticoagulants best can be used to treat them.

Now, the American Society of Hematology has released new guidelines to aid decision making about serious blood clotting complications affecting COVID-19 patients. Clinicians are urged to use a standard prophylactic anticoagulant dose over higher doses to prevent clotting in patients who have been hospitalized with novel coronavirus, including those in intensive care.

“The development of these guidelines was driven by the critical need to address serious and life-threatening blood clotting from COVID-19,” said Adam Cuker, MD, co-chair of the guideline panel and Associate Professor of Medicine at the University of Pennsylvania. “Hematologists are experts at treating blood clotting, and ASH has extensive experience with guideline development. These recommendations will continue to be updated to help shape front-line COVID-19 treatment.”

ASH guidelines offer advice for both critically ill hospitalized patients – essentially those in intensive care – and acutely ill hospitalized patients – those who require monitoring and treatment in the hospital outside of the ICU.

A press release from the specialty society points out that it is common for clinicians to administer anticoagulants to COVID-19 patients upon admission to try to prevent formation of blood clots but are uncertain about the right dose to administer.

The guidelines do not advise the use of higher doses of anticoagulants because that might pose greater risk for serious bleeding that outweighs potential benefits. Ultimately, however, the authors acknowledge that individualized decision-making should be employed, explaining that a higher dose of anticoagulants might be justified in patients considered to be at especially high clotting risk and low bleeding risk.

“COVID-19 is the most important public health problem of our lifetime, with more than one million deaths worldwide. Data suggest that abnormal blood clotting plays an important role in why patients die or get very sick from this disease. Thus, it is important that these patients be given anticoagulants to try to prevent clots, and data available right now suggest that standard dosing provides the best balance of benefits and risks,” said ASH President Stephanie Lee, MD, of Fred Hutchinson Cancer Research Center. “Equipping clinicians with evidence-based guidelines that focus on the prevention of clotting has the potential to save lives.”

The guidelines were the result of the formation in June of a multidisciplinary, internationally representative panel to offer evidence-based advice. The authors reviewed all available evidence, including early reports from observational studies.

ASH notes that development of the guidelines, including systematic evidence review, was supported by the McMaster University GRADE Centre, a world leader in guideline development. It emphasizes that, at this time, the best available evidence remains very low quality, and the recommendations are issued with conditions, explanations, and a call for more research.

“The systematic reviews and recommendations will continue to be maintained and updated, especially as better evidence from randomized clinical trials becomes available,” the group advises.

This month and next, according to ASH, the recommendations and a report of the guideline development process will undergo public review, as well as organizational review. When that is complete, the guidelines will be submitted for publication in the journal Blood Advances, although they might be somewhat different at that point since they will be updated as more evidence becomes available.