American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy
Shannon M Bates, Anita Rajasekhar, Saskia Middeldorp, Claire McLintock, Marc A Rodger, Andra H James, Sara R Vazquez, Ian A Greer, John J Riva, Meha Bhatt, Nicole Schwab, Danielle Barrett, Andrea LaHaye, Bram Rochwerg, Shannon M Bates, Anita Rajasekhar, Saskia Middeldorp, Claire McLintock, Marc A Rodger, Andra H James, Sara R Vazquez, Ian A Greer, John J Riva, Meha Bhatt, Nicole Schwab, Danielle Barrett, Andrea LaHaye, Bram Rochwerg
Abstract
Background: Venous thromboembolism (VTE) complicates ∼1.2 of every 1000 deliveries. Despite these low absolute risks, pregnancy-associated VTE is a leading cause of maternal morbidity and mortality.
Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and others in decisions about the prevention and management of pregnancy-associated VTE.
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.
Results: The panel agreed on 31 recommendations related to the treatment of VTE and superficial vein thrombosis, diagnosis of VTE, and thrombosis prophylaxis.
Conclusions: There was a strong recommendation for low-molecular-weight heparin (LWMH) over unfractionated heparin for acute VTE. Most recommendations were conditional, including those for either twice-per-day or once-per-day LMWH dosing for the treatment of acute VTE and initial outpatient therapy over hospital admission with low-risk acute VTE, as well as against routine anti-factor Xa (FXa) monitoring to guide dosing with LMWH for VTE treatment. There was a strong recommendation (low certainty in evidence) for antepartum anticoagulant prophylaxis with a history of unprovoked or hormonally associated VTE and a conditional recommendation against antepartum anticoagulant prophylaxis with prior VTE associated with a resolved nonhormonal provoking risk factor.
Conflict of interest statement
Conflict-of-interest disclosure: All authors were members of the guideline panel or members of the systematic review team or both. They completed disclosure-of-interest forms that were reviewed by ASH and are available as supplements 2 and 3.
© 2018 by The American Society of Hematology.
Source: PubMed