PDF(Pubmed)
Abstract：
Coronavirus disease 2019 (COVID-19)-related critical illness and acute illness are associated with a risk of venous thromboembolism (VTE).
These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in decisions about the use of anticoagulation for thromboprophylaxis for patients with COVID-19-related critical illness and acute illness who do not have confirmed or suspected VTE.
ASH formed a multidisciplinary guideline panel and applied strict management strategies to minimize potential bias from conflicts of interest. The panel included 3 patient representatives. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic evidence reviews (up to 19 August 2020). 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, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment.
The panel agreed on 2 recommendations. The panel issued conditional recommendations in favor of prophylactic-intensity anticoagulation over intermediate-intensity or therapeutic-intensity anticoagulation for patients with COVID-19-related critical illness or acute illness who do not have confirmed or suspected VTE.
These recommendations were based on very low certainty in the evidence, underscoring the need for high-quality, randomized controlled trials comparing different intensities of anticoagulation. They will be updated using a living recommendation approach as new evidence becomes available.
These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in decisions about the use of anticoagulation for thromboprophylaxis for patients with COVID-19-related critical illness and acute illness who do not have confirmed or suspected VTE.
ASH formed a multidisciplinary guideline panel and applied strict management strategies to minimize potential bias from conflicts of interest. The panel included 3 patient representatives. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic evidence reviews (up to 19 August 2020). 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, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment.
The panel agreed on 2 recommendations. The panel issued conditional recommendations in favor of prophylactic-intensity anticoagulation over intermediate-intensity or therapeutic-intensity anticoagulation for patients with COVID-19-related critical illness or acute illness who do not have confirmed or suspected VTE.
These recommendations were based on very low certainty in the evidence, underscoring the need for high-quality, randomized controlled trials comparing different intensities of anticoagulation. They will be updated using a living recommendation approach as new evidence becomes available.
摘要：
2019年冠状病毒病（COVID-19）相关危重症和急性疾病与静脉血栓栓塞（VTE）的风险相关。
美国血液学会（ASH）的这些循证指南旨在支持患者，临床医生,和其他卫生保健专业人员决定使用抗凝治疗未确诊或疑似VTE的COVID-19相关危重疾病和急性疾病患者的血栓预防。
ASH成立了一个多学科指南小组，并采用了严格的管理策略，以最大程度地减少利益冲突带来的潜在偏见。该小组包括3名患者代表。麦克马斯特大学年级中心支持指导方针制定过程，包括进行系统证据审查（截至2020年8月19日）。小组根据临床医生和患者的重要性，优先考虑临床问题和结果。小组使用了建议评估的分级，开发和评估（等级）方法，包括等级证据到决策框架，评估证据并提出建议，受到公众的评论。
专家小组同意2项建议。专家组发布了有条件的建议，支持对未确诊或疑似VTE的COVID-19相关危重疾病或急性疾病患者使用预防性强度抗凝，而不是中等强度或治疗强度抗凝。
这些建议是基于证据中非常低的确定性，强调对高质量的需求，比较不同抗凝强度的随机对照试验。随着新证据的出现，它们将使用活的推荐方法进行更新。
美国血液学会（ASH）的这些循证指南旨在支持患者，临床医生,和其他卫生保健专业人员决定使用抗凝治疗未确诊或疑似VTE的COVID-19相关危重疾病和急性疾病患者的血栓预防。
ASH成立了一个多学科指南小组，并采用了严格的管理策略，以最大程度地减少利益冲突带来的潜在偏见。该小组包括3名患者代表。麦克马斯特大学年级中心支持指导方针制定过程，包括进行系统证据审查（截至2020年8月19日）。小组根据临床医生和患者的重要性，优先考虑临床问题和结果。小组使用了建议评估的分级，开发和评估（等级）方法，包括等级证据到决策框架，评估证据并提出建议，受到公众的评论。
专家小组同意2项建议。专家组发布了有条件的建议，支持对未确诊或疑似VTE的COVID-19相关危重疾病或急性疾病患者使用预防性强度抗凝，而不是中等强度或治疗强度抗凝。
这些建议是基于证据中非常低的确定性，强调对高质量的需求，比较不同抗凝强度的随机对照试验。随着新证据的出现，它们将使用活的推荐方法进行更新。
