Practical Guidelines for Blood Thinners in COVID-19 Patients

It is important for multiple myeloma patients to stay up-to-date on COVID-19 issues as they are at higher risk of developing an infection. The American Society of Hematology recently released new guidelines to help doctors prevent serious blood clotting complications affecting COVID-19 patients. The recommendations suggest that a standard anticoagulant dose should be used instead of higher doses to prevent clotting in patients who have been hospitalized with COVID-19, including those in intensive care. 

It is well known that COVID-19 can cause excessive blood clotting and it can be a serious complication, especially for patients who are hospitalized. The new guidelines suggest the use of a standard prophylactic dose of anticoagulation upon admission to the hospital. The use of higher doses of anticoagulants is not recommended, as it may pose greater risk for serious bleeding that outweighs potential benefits. Physicians can administer higher doses if they are deemed appropriate to accomplish lower blood clotting in low bleed-risk patients.

“COVID-19 is the most important public health problem of our lifetime, with more than one million deaths worldwide. Data suggest that abnormal blood clotting plays an important role in why patients die or get very sick from this disease. Thus, it is important that these patients be given anticoagulants to try to prevent clots, and data available right now suggest that standard dosing provides the best balance of benefits and risks,” said ASH President Stephanie Lee, MD, of Fred Hutchinson Cancer Research Center. “Equipping clinicians with evidence-based guidelines that focus on the prevention of clotting has the potential to save lives.”

This summer, ASH formed an international multidisciplinary panel to develop the guidelines based on extensive research and evidence. The panel was chaired by Drs. Adam Cuker, of the University of Pennsylvania; Holger Schunemann, of McMaster University; and Reem Mustafa, of University of Kansas Medical Center. The panel urgently examined all available evidence, including early reports from observational studies. Development of these guidelines, including systematic evidence review, was supported by the McMaster University GRADE Centre, a world leader in guideline development. At this time, the best available evidence is very low quality, and the recommendations are framed with conditions, explanations, and a call for more research. The systematic reviews and recommendations will continue to be maintained and updated, especially as better evidence from randomized clinical trials becomes available. 

“The development of these guidelines was driven by the critical need to address serious and life-threatening blood clotting from COVID-19,” said Adam Cuker, MD, co-chair of the guideline panel and Associate Professor of Medicine at the University of Pennsylvania. “Hematologists are experts at treating blood clotting, and ASH has extensive experience with guideline development. These recommendations will continue to be updated to help shape front-line COVID-19 treatment.”

To read the full guidelines, click here.