. 2022 Aug 29;6(17):4975–4982. doi: 10.1182/bloodadvances.2022007940

Table 1.

Recommendations

Recommendation	Remarks
Recommendation 1b. The ASH guideline panel suggests using prophylactic-intensity over therapeutic-intensity anticoagulation for patients with COVID-19–related critical illness who do not have suspected or confirmed VTE (conditional recommendation based on very low certainty in the evidence about effects ⨁◯◯◯).	• Patients with COVID-19–related critical illness are defined as those suffering from an immediately life-threatening condition who would typically be admitted to an ICU. Examples include patients requiring hemodynamic support, ventilatory support, and renal replacement therapy. • A separate recommendation (1a) addresses the comparison of intermediate-intensity and prophylactic-intensity anticoagulation in critically ill patients with COVID-19. • An individualized assessment of the patient’s risk of thrombosis and bleeding is important when deciding on anticoagulation intensity. Risk assessment models to estimate thrombotic risk in hospitalized patients have been validated in patients with COVID-19 (critically or noncritically ill), with modest prognostic performance. No risk assessment models for bleeding have been validated in patients with COVID-19. The panel acknowledges that higher-intensity anticoagulation may be preferred for patients judged to be at low bleeding risk and high thrombotic risk. • At present, there is no direct high-certainty evidence comparing different types of anticoagulants for patients with COVID-19. Unfractionated or low-molecular-weight heparin was used in identified studies. • This recommendation does not apply to patients who require anticoagulation to prevent thrombosis of extracorporeal circuits such as extracorporeal membrane oxygenation or continuous renal replacement therapy.

Recommendation

Remarks

Recommendation 1b. The ASH guideline panel suggests using prophylactic-intensity over therapeutic-intensity anticoagulation for patients with COVID-19–related critical illness who do not have suspected or confirmed VTE (conditional recommendation based on very low certainty in the evidence about effects ⨁◯◯◯).

• Patients with COVID-19–related critical illness are defined as those suffering from an immediately life-threatening condition who would typically be admitted to an ICU. Examples include patients requiring hemodynamic support, ventilatory support, and renal replacement therapy.
• A separate recommendation (1a) addresses the comparison of intermediate-intensity and prophylactic-intensity anticoagulation in critically ill patients with COVID-19.
• An individualized assessment of the patient’s risk of thrombosis and bleeding is important when deciding on anticoagulation intensity. Risk assessment models to estimate thrombotic risk in hospitalized patients have been validated in patients with COVID-19 (critically or noncritically ill), with modest prognostic performance. No risk assessment models for bleeding have been validated in patients with COVID-19. The panel acknowledges that higher-intensity anticoagulation may be preferred for patients judged to be at low bleeding risk and high thrombotic risk.
• At present, there is no direct high-certainty evidence comparing different types of anticoagulants for patients with COVID-19. Unfractionated or low-molecular-weight heparin was used in identified studies.
• This recommendation does not apply to patients who require anticoagulation to prevent thrombosis of extracorporeal circuits such as extracorporeal membrane oxygenation or continuous renal replacement therapy.