ISTH guidelines for antithrombotic treatment in COVID-19

Area of Science:

• Cardiology
• Hematology
• Infectious Diseases

Background:

• Antithrombotic agents are crucial for managing thromboembolism in critically ill patients.
• The role of heparins and other antithrombotic agents in COVID-19 requires clarification regarding optimal dosing and timing.
• Existing evidence on antithrombotic strategies for COVID-19 patients necessitates expert consensus for clinical guidance.

Purpose of the Study:

• To develop evidence-based recommendations for anticoagulant and antiplatelet therapy in COVID-19 patients across various clinical settings.
• To provide guidance on the use of heparins and other antithrombotic agents for hospitalized and non-hospitalized COVID-19 patients.
• To address optimal dosing, timing, and combination strategies for antithrombotic treatments in the context of COVID-19.

Main Methods:

• An international panel of experts, patient representatives, and a methodologist convened in October 2021.
• Recommendations were developed using the American College of Cardiology Foundation/American Heart Association methodology for assessing Level of Evidence (LOE) and Class of Recommendation (COR).
• Only recommendations with LOE A or B were included, focusing on high- and moderate-quality evidence available through March 2022.

Main Results:

• Twelve recommendations were established for different patient groups: non-hospitalized, non-critically ill hospitalized, critically ill hospitalized, and post-discharge.
• Strong recommendations include prophylactic low molecular weight heparin or unfractionated heparin (LMWH/UFH) for non-critically ill hospitalized patients, with therapeutic doses for select individuals.
• Advice against adding antiplatelet agents to prophylactic LMWH/UFH in non-critically ill hospitalized patients was also provided.

Conclusions:

• The guidelines offer clear recommendations for antithrombotic therapy in COVID-19 patients based on robust evidence.
• Specific guidance is provided for prophylactic and therapeutic heparin use, as well as the judicious use of antiplatelet agents.
• Future updates will incorporate emerging evidence to refine these recommendations for evolving clinical practice.