ASH published several clinical practice guidelines in Blood Advances this year and plans to release several more in the coming year. Three sickle cell disease (SCD) guidelines, one acute myeloid leukemia (AML) guideline, and one venous thromboembolism (VTE) guideline were published between January and October of this year, and guidelines covering the use of anticoagulation in patients with COVID-19 were released for public comment in early October. At the time of writing this update, three guidelines, one for VTE and two for von Willebrand disease (VWD), were slated for publication by the end of the year.
These, like all ASH clinical practice guidelines, were developed by leading clinical, methodological, and patient experts through a rigorous process to review evidence and write actionable recommendations, a methodology that ensures the guidelines meet the highest standards for trustworthiness and transparency.
The SCD guidelines published in 2020 include transfusion support, cerebrovascular disease, and management of acute and chronic pain. The SCD guideline on transfusion support aimed to support patients, clinicians, and other health care professionals in their decisions about transfusion support for SCD and the management of transfusion-related complications. The SCD guideline on cerebrovascular disease intended to support the SCD community in decisions about prevention, diagnosis, and treatment of the most common neurological morbidities in SCD. Finally, the SCD guideline on the management of acute and chronic pain was designed to support patients, clinicians, and other health care professionals in pain management decisions for children and adults with SCD. Chair of the SCD-Transfusion Support Guideline Panel Dr. Stella Chou expressed the significance of these guidelines. “I think what’s unique about the questions we addressed in these guidelines,” she said, “is that we asked ourselves as clinicians, as the treaters of patients with SCD, ‘What do we need help with?’ We knew going into this process that there would be a paucity of evidence…There are no large randomized controlled trials for any of the topics that we chose, but they are the everyday dilemmas we face.”
Co-chair of the Cerebrovascular Panel for the SCD Guidelines Dr. Michael R. DeBaun explained that there is a range of reasons for developing these guidelines, but he highlighted three main motives in an interview with ASH. “Individuals and their family members who are affected by a disease do not have readily available access to information that allows them to understand the best evidence guidelines to prevent and treat one of the most common and serious complications of the disease, which is injury to the brain and cognitive impairment,” he said. Dr. DeBaun added that the information provided in the guideline is meant to guide permanent care providers, most of which have little expertise in managing a rare disease, specifically SCD. “These guidelines will serve as an easy, accessible reference to help them prevent and treat neurological complications of this disease,” he said. His third point was that the guidelines can be used by policymakers and institutions that provide funding to identify best strategies for care as well as areas of need, which demonstrates the usefulness of guidelines, not just in practice, but even in advocacy and policymaking.
The AML guideline released in 2020 sought to support patients, clinicians, and other health care professionals in their decisions about management of AML in older adults. A VTE guideline published in October aimed to support patients, clinicians, and other health care professionals in decisions about treatment of VTE, including deep vein thrombosis and pulmonary embolism, which occur in approximately one to two individuals per 1,000 each year in the United States. Co-chair of the Guideline Panel on Treatment of VTE Dr. Thomas L. Ortel stated that the intent of this guideline is to help the provider think their way through how they’re going to manage the patient, without locking them into any treatment plan. “The guidelines serve as a background to guide providers through careful consideration of different medications for the individual patient through different phases and options for treatment and therapy,” said Dr. Ortel. Another VTE guideline, on the management of cancer-associated thrombosis, is anticipated to be published by December 2020/January 2021 at the time of this writing.
In June 2020, in the midst of the COVID-19 pandemic, ASH formed a multidisciplinary, international panel to develop guidelines on the use of anticoagulation in patients with COVID-19, with a panel prioritizing questions about the use of anticoagulation in critically and acutely ill patients. Recommendations included using prophylactic-intensity over intermediate-intensity or therapeutic-intensity anticoagulation in patients with COVID-19–related critical or acute illness who do not have suspected or confirmed VTE. The draft recommendations were opened for public comment in October. The recommendations and a report of the guideline development process will undergo public review and ASH organizational review and approval, as all guidelines do, and will then be submitted for publication in Blood Advances.
Two guidelines covering the diagnosis and management of VWD are expected to be published before the annual meeting. Meanwhile in 2021, a VTE guideline on thrombophilia, an SCD guideline on stem cell transplantation, and ongoing “living” updates to the guideline on the use of anticoagulation in patients with COVID-19, are scheduled for early in the year.
Visit www.hematology.org/guidelines to stay up to date with all of the ASH clinical practice guidelines.
Available and Upcoming Webinars
The multidisciplinary, international panel formed by ASH in June 2020 to develop guidelines on the use of anticoagulation in acutely and critically ill patients with COVID-19 has released their recommendations, highlighted in a webinar along with underlying evidence and rationale for these ASH Guidelines on Use of Anticoagulation in Patients With COVID-19 recommendations.
A webinar on the Guidelines on the Diagnosis and Management of Von Willebrand Disease developed by ASH in partnership with the International Society of Thrombosis and Haemostasis, National Hemophilia Foundation, World Federation of Hemophilia, and the University of Kansas Medical Center, is scheduled for Monday, January 25, at 2:00 p.m. Eastern Time. The webinar will highlight the guideline recommendations along with the underlying evidence and rationale for them. Learn more and register online.