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2023 ISTH update of the 2022 ISTH guidelines for antithrombotic treatment in COVID-19.

Publication ,  Journal Article
Schulman, S; Arnold, DM; Bradbury, CA; Broxmeyer, L; Connors, JM; Falanga, A; Iba, T; Kaatz, S; Levy, JH; Middeldorp, S; Minichiello, T ...
Published in: J Thromb Haemost
June 2024

Based on emerging evidence from the COVID-19 pandemic, the International Society on Thrombosis and Haemostasis (ISTH) guidelines for antithrombotic treatment in COVID-19 were published in 2022. Since then, at least 16 new randomized controlled trials have contributed additional evidence, which necessitated a modification of most of the previous recommendations. We used again the American College of Cardiology Foundation/American Heart Association methodology for assessment of level of evidence (LOE) and class of recommendation (COR). Five recommendations had the LOE upgraded to A and 2 new recommendations on antithrombotic treatment for patients with COVID-19 were added. Furthermore, a section was added to answer questions about COVID-19 vaccination and vaccine-induced immune thrombotic thrombocytopenia (VITT), for which studies have provided some evidence. We only included recommendations with LOE A or B. Panelists agreed on 19 recommendations, 4 for nonhospitalized, 5 for noncritically ill hospitalized, 3 for critically ill hospitalized, and 2 for postdischarge patients, as well as 5 for vaccination and VITT. A strong recommendation (COR 1) was given for (a) use of prophylactic dose of low-molecular-weight heparin or unfractionated heparin in noncritically ill patients hospitalized for COVID-19, (b) for select patients in this group, use of therapeutic-dose low-molecular-weight heparin/unfractionated heparin in preference to prophylactic dose, and (c) for use of antiplatelet factor 4 enzyme immunoassays for diagnosing VITT. A strong recommendation was given against (COR 3) the addition of an antiplatelet agent in hospitalized, noncritically ill patients. These international guidelines provide recommendations for countries with diverse healthcare resources and COVID-19 vaccine availability.

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Published In

J Thromb Haemost

DOI

EISSN

1538-7836

Publication Date

June 2024

Volume

22

Issue

6

Start / End Page

1779 / 1797

Location

England

Related Subject Headings

  • Thrombosis
  • SARS-CoV-2
  • Platelet Aggregation Inhibitors
  • Humans
  • Fibrinolytic Agents
  • Cardiovascular System & Hematology
  • COVID-19 Vaccines
  • COVID-19 Drug Treatment
  • COVID-19
  • Anticoagulants
 

Citation

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Schulman, S., Arnold, D. M., Bradbury, C. A., Broxmeyer, L., Connors, J. M., Falanga, A., … International Society on Thrombosis and Haemostasis. (2024). 2023 ISTH update of the 2022 ISTH guidelines for antithrombotic treatment in COVID-19. J Thromb Haemost, 22(6), 1779–1797. https://doi.org/10.1016/j.jtha.2024.02.011
Schulman, Sam, Donald M. Arnold, Charlotte A. Bradbury, Lisa Broxmeyer, Jean Marie Connors, Anna Falanga, Toshiaki Iba, et al. “2023 ISTH update of the 2022 ISTH guidelines for antithrombotic treatment in COVID-19.J Thromb Haemost 22, no. 6 (June 2024): 1779–97. https://doi.org/10.1016/j.jtha.2024.02.011.
Schulman S, Arnold DM, Bradbury CA, Broxmeyer L, Connors JM, Falanga A, et al. 2023 ISTH update of the 2022 ISTH guidelines for antithrombotic treatment in COVID-19. J Thromb Haemost. 2024 Jun;22(6):1779–97.
Schulman, Sam, et al. “2023 ISTH update of the 2022 ISTH guidelines for antithrombotic treatment in COVID-19.J Thromb Haemost, vol. 22, no. 6, June 2024, pp. 1779–97. Pubmed, doi:10.1016/j.jtha.2024.02.011.
Schulman S, Arnold DM, Bradbury CA, Broxmeyer L, Connors JM, Falanga A, Iba T, Kaatz S, Levy JH, Middeldorp S, Minichiello T, Nazy I, Ramacciotti E, Resnick HE, Samama CM, Sholzberg M, Thachil J, Zarychanski R, Spyropoulos AC, International Society on Thrombosis and Haemostasis. 2023 ISTH update of the 2022 ISTH guidelines for antithrombotic treatment in COVID-19. J Thromb Haemost. 2024 Jun;22(6):1779–1797.
Journal cover image

Published In

J Thromb Haemost

DOI

EISSN

1538-7836

Publication Date

June 2024

Volume

22

Issue

6

Start / End Page

1779 / 1797

Location

England

Related Subject Headings

  • Thrombosis
  • SARS-CoV-2
  • Platelet Aggregation Inhibitors
  • Humans
  • Fibrinolytic Agents
  • Cardiovascular System & Hematology
  • COVID-19 Vaccines
  • COVID-19 Drug Treatment
  • COVID-19
  • Anticoagulants