American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy

In July 2022, these guidelines were reviewed by an expert work group convened by ASH. Review included limited searches for new evidence and discussion of the search results. Following this review, the ASH Committee on Quality agreed to continue monitoring the supporting evidence rather than revise o...

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Published in:	Blood advances Vol. 2; no. 22; pp. 3257 - 3291
Main Authors:	Witt, Daniel M., Nieuwlaat, Robby, Clark, Nathan P., Ansell, Jack, Holbrook, Anne, Skov, Jane, Shehab, Nadine, Mock, Juliet, Myers, Tarra, Dentali, Francesco, Crowther, Mark A., Agarwal, Arnav, Bhatt, Meha, Khatib, Rasha, Riva, John J., Zhang, Yuan, Guyatt, Gordon
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 27.11.2018 American Society of Hematology
Subjects:	Administration, Oral Anticoagulants - therapeutic use ATP Binding Cassette Transporter, Subfamily B - antagonists & inhibitors ATP Binding Cassette Transporter, Subfamily B - metabolism Clinical Guidelines Cytochrome P-450 Enzyme System - chemistry Cytochrome P-450 Enzyme System - metabolism Evidence-Based Medicine Heparin - therapeutic use Heparin, Low-Molecular-Weight - therapeutic use Humans International Normalized Ratio Medication Adherence Point-of-Care Systems Venous Thromboembolism - drug therapy Vitamin K - antagonists & inhibitors
ISSN:	2473-9529, 2473-9537, 2473-9537
Online Access:	Get full text
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Abstract	In July 2022, these guidelines were reviewed by an expert work group convened by ASH. Review included limited searches for new evidence and discussion of the search results. Following this review, the ASH Committee on Quality agreed to continue monitoring the supporting evidence rather than revise or retire these guidelines at this time. Limited searches and expert review will be repeated annually going forward until these guidelines are revised or retired. Background: Clinicians confront numerous practical issues in optimizing the use of anticoagulants to treat venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and other health care professionals in their decisions about the use of anticoagulants in the management of VTE. These guidelines assume the choice of anticoagulant has already been made. Methods: ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 25 recommendations and 2 good practice statements to optimize management of patients receiving anticoagulants. Conclusions: Strong recommendations included using patient self-management of international normalized ratio (INR) with home point-of-care INR monitoring for vitamin K antagonist therapy and against using periprocedural low-molecular-weight heparin (LMWH) bridging therapy. Conditional recommendations included basing treatment dosing of LMWH on actual body weight, not using anti–factor Xa monitoring to guide LMWH dosing, using specialized anticoagulation management services, and resuming anticoagulation after episodes of life-threatening bleeding.
AbstractList	In July 2022, these guidelines were reviewed by an expert work group convened by ASH. Review included limited searches for new evidence and discussion of the search results. Following this review, the ASH Committee on Quality agreed to continue monitoring the supporting evidence rather than revise or retire these guidelines at this time. Limited searches and expert review will be repeated annually going forward until these guidelines are revised or retired. Background: Clinicians confront numerous practical issues in optimizing the use of anticoagulants to treat venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and other health care professionals in their decisions about the use of anticoagulants in the management of VTE. These guidelines assume the choice of anticoagulant has already been made. Methods: ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 25 recommendations and 2 good practice statements to optimize management of patients receiving anticoagulants. Conclusions: Strong recommendations included using patient self-management of international normalized ratio (INR) with home point-of-care INR monitoring for vitamin K antagonist therapy and against using periprocedural low-molecular-weight heparin (LMWH) bridging therapy. Conditional recommendations included basing treatment dosing of LMWH on actual body weight, not using anti–factor Xa monitoring to guide LMWH dosing, using specialized anticoagulation management services, and resuming anticoagulation after episodes of life-threatening bleeding. Background: Clinicians confront numerous practical issues in optimizing the use of anticoagulants to treat venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and other health care professionals in their decisions about the use of anticoagulants in the management of VTE. These guidelines assume the choice of anticoagulant has already been made. Methods: ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 25 recommendations and 2 good practice statements to optimize management of patients receiving anticoagulants. Conclusions: Strong recommendations included using patient self-management of international normalized ratio (INR) with home point-of-care INR monitoring for vitamin K antagonist therapy and against using periprocedural low-molecular-weight heparin (LMWH) bridging therapy. Conditional recommendations included basing treatment dosing of LMWH on actual body weight, not using anti–factor Xa monitoring to guide LMWH dosing, using specialized anticoagulation management services, and resuming anticoagulation after episodes of life-threatening bleeding. Clinicians confront numerous practical issues in optimizing the use of anticoagulants to treat venous thromboembolism (VTE).BACKGROUNDClinicians confront numerous practical issues in optimizing the use of anticoagulants to treat venous thromboembolism (VTE).These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and other health care professionals in their decisions about the use of anticoagulants in the management of VTE. These guidelines assume the choice of anticoagulant has already been made.OBJECTIVEThese evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and other health care professionals in their decisions about the use of anticoagulants in the management of VTE. These guidelines assume the choice of anticoagulant has already been made.ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment.METHODSASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment.The panel agreed on 25 recommendations and 2 good practice statements to optimize management of patients receiving anticoagulants.RESULTSThe panel agreed on 25 recommendations and 2 good practice statements to optimize management of patients receiving anticoagulants.Strong recommendations included using patient self-management of international normalized ratio (INR) with home point-of-care INR monitoring for vitamin K antagonist therapy and against using periprocedural low-molecular-weight heparin (LMWH) bridging therapy. Conditional recommendations included basing treatment dosing of LMWH on actual body weight, not using anti-factor Xa monitoring to guide LMWH dosing, using specialized anticoagulation management services, and resuming anticoagulation after episodes of life-threatening bleeding.CONCLUSIONSStrong recommendations included using patient self-management of international normalized ratio (INR) with home point-of-care INR monitoring for vitamin K antagonist therapy and against using periprocedural low-molecular-weight heparin (LMWH) bridging therapy. Conditional recommendations included basing treatment dosing of LMWH on actual body weight, not using anti-factor Xa monitoring to guide LMWH dosing, using specialized anticoagulation management services, and resuming anticoagulation after episodes of life-threatening bleeding. Clinicians confront numerous practical issues in optimizing the use of anticoagulants to treat venous thromboembolism (VTE). These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and other health care professionals in their decisions about the use of anticoagulants in the management of VTE. These guidelines assume the choice of anticoagulant has already been made. ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment. The panel agreed on 25 recommendations and 2 good practice statements to optimize management of patients receiving anticoagulants. Strong recommendations included using patient self-management of international normalized ratio (INR) with home point-of-care INR monitoring for vitamin K antagonist therapy and against using periprocedural low-molecular-weight heparin (LMWH) bridging therapy. Conditional recommendations included basing treatment dosing of LMWH on actual body weight, not using anti-factor Xa monitoring to guide LMWH dosing, using specialized anticoagulation management services, and resuming anticoagulation after episodes of life-threatening bleeding.
Author	Khatib, Rasha Dentali, Francesco Guyatt, Gordon Witt, Daniel M. Nieuwlaat, Robby Agarwal, Arnav Skov, Jane Ansell, Jack Mock, Juliet Holbrook, Anne Crowther, Mark A. Bhatt, Meha Clark, Nathan P. Zhang, Yuan Myers, Tarra Riva, John J. Shehab, Nadine
Author_xml	– sequence: 1 givenname: Daniel M. surname: Witt fullname: Witt, Daniel M. email: dan.witt@pharm.utah.edu organization: Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, UT – sequence: 2 givenname: Robby surname: Nieuwlaat fullname: Nieuwlaat, Robby organization: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada – sequence: 3 givenname: Nathan P. surname: Clark fullname: Clark, Nathan P. organization: Clinical Pharmacy Anticoagulation and Anemia Service, Kaiser Permanente Colorado, Aurora, CO – sequence: 4 givenname: Jack surname: Ansell fullname: Ansell, Jack organization: School of Medicine, Hofstra Northwell, Hempstead, NY – sequence: 5 givenname: Anne surname: Holbrook fullname: Holbrook, Anne organization: Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, Hamilton, ON, Canada – sequence: 6 givenname: Jane surname: Skov fullname: Skov, Jane organization: Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark – sequence: 7 givenname: Nadine surname: Shehab fullname: Shehab, Nadine organization: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA – sequence: 8 givenname: Juliet surname: Mock fullname: Mock, Juliet organization: Aurora Medical Center Summit, Summit, WI – sequence: 9 givenname: Tarra surname: Myers fullname: Myers, Tarra organization: Cambridge, ON, Canada – sequence: 10 givenname: Francesco surname: Dentali fullname: Dentali, Francesco organization: Department of Medicine and Surgery, Insubria University, Varese, Italy – sequence: 11 givenname: Mark A. surname: Crowther fullname: Crowther, Mark A. organization: Department of Medicine, McMaster University, Hamilton, ON, Canada – sequence: 12 givenname: Arnav orcidid: 0000-0002-0931-7851 surname: Agarwal fullname: Agarwal, Arnav organization: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada – sequence: 13 givenname: Meha surname: Bhatt fullname: Bhatt, Meha organization: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada – sequence: 14 givenname: Rasha surname: Khatib fullname: Khatib, Rasha organization: Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL – sequence: 15 givenname: John J. surname: Riva fullname: Riva, John J. organization: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada – sequence: 16 givenname: Yuan orcidid: 0000-0002-4174-0641 surname: Zhang fullname: Zhang, Yuan organization: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada – sequence: 17 givenname: Gordon surname: Guyatt fullname: Guyatt, Gordon organization: Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/30482765$$D View this record in MEDLINE/PubMed
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Snippet	In July 2022, these guidelines were reviewed by an expert work group convened by ASH. Review included limited searches for new evidence and discussion of the... Background: Clinicians confront numerous practical issues in optimizing the use of anticoagulants to treat venous thromboembolism (VTE). Objective: These... Clinicians confront numerous practical issues in optimizing the use of anticoagulants to treat venous thromboembolism (VTE). These evidence-based guidelines of... Clinicians confront numerous practical issues in optimizing the use of anticoagulants to treat venous thromboembolism (VTE).BACKGROUNDClinicians confront...
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SubjectTerms	Administration, Oral Anticoagulants - therapeutic use ATP Binding Cassette Transporter, Subfamily B - antagonists & inhibitors ATP Binding Cassette Transporter, Subfamily B - metabolism Clinical Guidelines Cytochrome P-450 Enzyme System - chemistry Cytochrome P-450 Enzyme System - metabolism Evidence-Based Medicine Heparin - therapeutic use Heparin, Low-Molecular-Weight - therapeutic use Humans International Normalized Ratio Medication Adherence Point-of-Care Systems Venous Thromboembolism - drug therapy Vitamin K - antagonists & inhibitors
Title	American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy
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