Journal article
Thromboprophylaxis in Patients With COVID-19 A Brief Update to the CHEST Guideline and Expert Panel Report
Chest, Vol.162(1), pp.213-225
07/01/2022
DOI: 10.1016/j.chest.2022.02.006
PMCID: PMC8839802
PMID: 35167861
Abstract
BACKGROUND: Patients hospitalized with COVID-19 often exhibit markers of a hypercoagulable state and have an increased incidence of VTE. In response, CHEST issued rapid clinical guidance regarding prevention of VTE. Over the past 18 months the quality of the evidence has improved. We thus sought to incorporate this evidence and update our recommendations as necessary.
STUDY DESIGN AND METHODS: This update focuses on the optimal approach to thromboprophylaxis in hospitalized patients. The original questions were used to guide the search, using MEDLINE via PubMed. Eight randomized controlled trials and one observational study were included. Meta-analysis, using a random effects model, was performed. The panel created summaries using the GRADE Evidence-to-Decision framework. Updated guidance statements were drafted, and a modified Delphi approach was used to obtain consensus.
RESULTS: We provide separate guidance statements for VTE prevention for hospitalized patients with acute (moderate) illness and critically ill patients in the ICU. However, we divided each original question and resulting recommendation into two questions: standard prophylaxis vs therapeutic (or escalated dose) prophylaxis and standard prophylaxis vs intermediate dose prophylaxis. This led to a change in one recommendation, and an upgrading of three additional recommendations based upon higher quality evidence.
CONCLUSIONS: Advances in care for patients with COVID-19 have improved overall outcomes. Despite this, rates of VTE in these patients remain elevated. Critically ill patients should receive standard thromboprophylaxis for VTE, and moderately ill patients with a low bleeding risk might benefit from therapeutic heparin. We see no role for intermediate dose thromboprophylaxis in either setting.
Details
- Title: Subtitle
- Thromboprophylaxis in Patients With COVID-19 A Brief Update to the CHEST Guideline and Expert Panel Report
- Creators
- Lisa K. Moores - Uniformed Services University of the Health SciencesTobias Tritschler - University of BernShari Brosnahan - New York Univ Langone Hlth Syst, Div Pulm Crit Care & Sleep Med, New York, NY USAMarc Carrier - University of OttawaJacob F. Collen - Uniformed Services University of the Health SciencesKevin Doerschug - University of IowaAaron B. Holley - Walter Reed National Military Medical CenterJonathan Iaccarino - Amer Coll Chest Phys, Glenview, IL USADavid Jimenez - Hospital Universitario Ramón y CajalGregoire LeGal - University of OttawaParth Rali - Temple UniversityPhilip Wells - University of Ottawa
- Resource Type
- Journal article
- Publication Details
- Chest, Vol.162(1), pp.213-225
- Publisher
- Elsevier
- DOI
- 10.1016/j.chest.2022.02.006
- PMID
- 35167861
- PMCID
- PMC8839802
- ISSN
- 0012-3692
- eISSN
- 1931-3543
- Number of pages
- 13
- Language
- English
- Date published
- 07/01/2022
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984359669002771
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