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

AI Article Synopsis

  • The ISTH updated its antithrombotic treatment guidelines for COVID-19 in 2022 based on new evidence from 16 randomized controlled trials, resulting in significant changes to previous recommendations.
  • Five recommendations were upgraded to level A evidence, while two new recommendations were added, addressing treatment for various patient categories and COVID-19 vaccination concerns.
  • Strong guidelines were established regarding the use of heparin in noncritically ill hospitalized COVID-19 patients and the diagnosis of vaccine-induced immune thrombotic thrombocytopenia (VITT), with specific contraindications noted for antiplatelet agents in certain groups.

Article Abstract

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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Source
http://dx.doi.org/10.1016/j.jtha.2024.02.011DOI Listing

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