ASH Clinical Practice Guidelines Expand During 2021

The ASH Clinical Practice Guidelines are developed by leading clinical, methodological, and patient experts through a rigorous process that includes review of evidence and writing of actionable recommendations, ensuring that they meet the highest standards for trustworthiness and transparency. This year, ASH not only continued its arduous work to develop additional Guidelines on Venous Thromboembolism (VTE) and Sickle Cell Disease (SCD), but adapted the ASH VTE Clinical Practice Guidelines on VTE for the Latin American context. Additionally, in response to the COVID-19 pandemic, ASH developed living clinical practice guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19.  

The ASH Clinical Practice Guidelines on Use of Anticoagulation in Patients With COVID-19 were initially published in 2020 on the ASH website and in Blood Advances in 2021 with recommendations for critically ill and acutely ill hospitalized patients with COVID-19. This effort came about as a direct response to the pandemic in 2020 and to address rapidly changing evidence, ASH has maintained these guidelines using a living approach – through continuous literature review, evidence synthesis, and reconsideration of the recommendations by the guideline panel. “We are putting a lot of emphasis on synthesizing and very carefully reviewing the evidence, the limitations, and the important points that we can pay attention to or where we should be more cautious in applying the evidence ... We are very transparent and explicit about all that in the guideline document,” explained guideline panel and methods co-chair Dr. Reem Mustafa. This panel revised and reissued two recommendations in 2021 and agreed upon an additional recommendation for thromboprophylaxis in discharged patients. The Hematologist podcast episode 103 contains additional discussion of these guidelines.  

Another of the Society’s significant guideline efforts under the VTE umbrella is the ASH VTE Clinical Practice Guidelines for Latin America. ASH partnered with 12 hematology societies from Latin America in 2018 to adapt the VTE guidelines for the Latin American context. A panel composed of members from several Latin American countries prioritized questions from the original ASH VTE guidelines, reviewed the original evidence along with available local evidence, and formed contextualized recommendations. A series of publications is also planned, with the first offering recommendations about treatment and management of VTE published in 2021, along with a methodology article. These recommendations are available in English, Spanish, and Portuguese. Learn more on the website, and listen to The Hematologist podcast episodes 99 (English), 100 (Spanish), and 101 (Portuguese).  

Also in 2021, ASH published the ASH Clinical Practice Guidelines for the Management of VTE: Prevention and Treatment in Patients with Cancer aimed to support patients, clinicians, and other health care professionals in their decision-making for patients with cancer who are at an increased risk of morbidity and mortality. Chair of the ASH Committee on Quality Dr. Lisa Hicks elaborated on the importance of this guideline saying, “Blood clots are a relatively common complication of cancer and can lead to symptoms, hospitalizations, and sometimes even death. The ASH Guidelines for Prevention and Treatment of VTE in Patients with Cancer provide clear, transparent, evidence-based guidance to help clinicians both prevent and manage this important disorder.” Find additional information and relevant resources by visiting the ASH website.  

This year, ASH in collaboration with the International Society on Thrombosis and Haemostasis (ISTH), National Hemophilia Foundation (NHF), and World Federation of Hemophilia (WFH), developed clinical practice guidelines on the diagnosis and management of von Willebrand disease (VWD), which is the most common inherited bleeding disorder known in humans. ASH ISTH NHF WFH Clinical Practice Guidelines on VWD panel co-chair Dr. Nathan Connell explained the significance of these efforts. “Given that von Willebrand disease is the most common inherited bleeding disorder, hematologists are frequently asked to assist with diagnosis or to provide guidance for management of bleeding symptoms,” he said. “Management options are directly connected to an accurate diagnosis, so these new guidelines from ASH, ISTH, NHF, and the WFH will help patients access appropriate care for their bleeding disorder.” Visit www.hematology.org/education/clinicians/guidelines-and-quality-care/clinical-practice-guidelines/von-willebrand-disease www.hematology.org/VWDguidelines for more information and resources from ASH and all partner societies.  

Lastly, a fifth and final chapter of the ASH Clinical Practice Guidelines for SCD was published in Blood Advances this year. The guideline is intended to support patients, clinicians, and health care professionals in their decisions about hematopoietic stem cell transplantation for SCD. Visit the ASH website to learn more.  

The ASH website features an array of resources for clinicians including the ASH Clinical Practice Guidelines app, which features recommendations from all guidelines and evidence-to-decision frameworks. The ASH Pocket Guides app offers digital versions of the ASH Clinical Practice Guidelines pocket guides as well as resources and access to tools such as the 4Ts Clinical Probability Scoring for Heparin-Induced Thrombocytopenia, Bleeding Score, and decision trees for initial warfarin dosing, among others. To download these apps, available for iOS and Android devices, and to access all resources, visit the ASH website.  

ASH accepts proposals for new clinical practice guidelines on a continuous basis, and these proposals are reviewed annually by the ASH Committee on Quality. The review process prioritizes topics on the basis of several factors including relevance to the field of hematology, need for guidelines, and impact to the field and community. Draft guidelines are made available for public comment prior to Society approval and publication. Anyone is welcome to comment on proposed recommendations, including ASH members, nonmember physicians and researchers, allied health professionals, industry representatives and insurance companies, patients, caregivers, and members of the public. More about the process and access the full collection of ASH Clinical Practice Guidelines and an array of resources, is available at www.hematology.org/guidelines.  

At the 2021 ASH Annual Meeting, several sessions will provide the latest updates on the ASH Clinical Practice Guidelines efforts. Please mark your calendar or access these sessions later on the virtual platform.

  *All times are Eastern time. GWCC, Georgia World Congress Center.