ASH, CHEST, AABB, and related heme/onc guidelines.

8 topics · 11 versions · 2 high-yield

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Cancer-associated thrombosis

cancer-associated-thrombosis

The 2022 ITAC international clinical practice guidelines provide GRADE-based recommendations for treatment and prophylaxis of venous thromboembolism (VTE) in patients with cancer, including those with COVID-19. This update incorporates new RCT evidence supporting direct oral anticoagulants (DOACs) as first-line options alongside LMWH for cancer-associated thrombosis, addresses primary prophylaxis with DOACs in ambulatory patients with elevated Khorana scores, and adds new guidance for cancer patients with COVID-19.

Heparin-induced thrombocytopenia (HIT)

hit · society: ASH

ASH 2018 evidence-based guideline on diagnosis and management of heparin-induced thrombocytopenia (HIT), an IgG-mediated prothrombotic reaction to PF4/heparin complexes. The 33 recommendations cover platelet monitoring, use of the 4Ts score with sequential immunoassay/functional assay testing, treatment of acute HIT with non-heparin anticoagulants, and special situations (cardiac surgery, PCI, renal replacement, VTE prophylaxis, history of HIT). Novel features vs prior guidelines: an integrated diagnostic algorithm and explicit inclusion of fondaparinux and DOACs as acceptable options for acute HIT.

Iron-deficiency anemia (GI evaluation)

ida-gi-evaluation · society: AGA

AGA 2020 guideline on the gastrointestinal evaluation of iron deficiency anemia (IDA), developed using GRADE. Covers ferritin cutoff for diagnosis, endoscopic evaluation strategy by sex/menopausal status, and workup for H. pylori, celiac disease, atrophic gastritis, and small-bowel sources after negative bidirectional endoscopy. Does not address refractory/recurrent IDA, obscure GI bleeding, or iron replacement regimens.

Immune thrombocytopenia (ITP)

itp · society: ASH

ASH 2019 guidelines provide 21 evidence-based recommendations for managing adults and children with newly diagnosed, persistent, and chronic ITP with non–life-threatening bleeding. Management options addressed include observation, corticosteroids, IVIG, anti-D immunoglobulin, rituximab, splenectomy, and TPO-RAs. Compared with the 2011 guideline, the update favors shorter corticosteroid courses, emphasizes shared decision-making for second-line therapy, and incorporates TPO-RAs as a preferred second-line option in both adults and children. The guideline does not cover diagnosis, life-threatening bleeding, pregnancy, or agents introduced after 2017.

RBC transfusion thresholds ⭐

rbc-transfusion · society: AABB · high-yield

The 2023 AABB international guideline updates RBC transfusion recommendations for hospitalized adults and children based on 45 adult RCTs (n=20,599) and 7 pediatric RCTs (n=2,730). For hemodynamically stable patients, restrictive thresholds (typically Hgb <7 g/dL) are non-inferior to liberal thresholds (9–10 g/dL) for mortality and major morbidity. New since 2016: explicit pediatric recommendations, including separate thresholds by cardiac repair stage in congenital heart disease, and extension of restrictive strategy to hematology/oncology inpatients.

Sickle cell disease

sickle-cell

ASH 2019 guidelines on cardiopulmonary and kidney disease in sickle cell disease (SCD) address screening and management of pulmonary hypertension, sleep-disordered breathing, abnormal pulmonary function, venous thromboembolism, albuminuria, and chronic kidney disease. The panel generally recommends against routine screening of asymptomatic patients with echocardiography, polysomnography, or pulmonary function testing, favoring targeted evaluation based on signs and symptoms. Recommendations also address anticoagulation duration for VTE, ACEi/ARB use for albuminuria, renal transplant referral, and combined hydroxyurea plus erythropoiesis-stimulating agent therapy for CKD-related anemia.

  • 2020 · ASH — ASH 2014–2020 Sickle Cell Disease Guideline Series
    • Pocket-guide series. Primary file (Cardiopulmonary & Kidney Disease) at source.pdf.local. Companion pocket guides in same folder: 2020-ash-chronic-complications.pdf, 2020-ash-hydroxyurea.pdf, 2020-ash-transfusion.pdf.
    • Read the guideline: html · Anki deck
  • 2014 · NHLBI — NHLBI 2014 SCD Guideline

VTE prophylaxis (hospitalized medical patients)

vte-prophylaxis-medical · society: ASH

ASH 2018 evidence-based guidelines on VTE prevention in hospitalized and nonhospitalized medical patients, including acutely ill inpatients, critically ill inpatients, chronically ill/long-term care residents, outpatients with minor provoking factors, and long-distance travelers. Nineteen GRADE-based recommendations address pharmacologic vs mechanical prophylaxis, agent selection (UFH, LMWH, fondaparinux, DOACs, aspirin), duration, and post-discharge extension. Strong recommendations include pharmacologic prophylaxis for acutely/critically ill inpatients at acceptable bleeding risk, LMWH over DOACs in hospital, and against extended outpatient prophylaxis after discharge.

VTE treatment & prophylaxis ⭐

vte-treatment · high-yield

Second update to the CHEST 9th edition guidelines on antithrombotic therapy for VTE, providing 29 guidance statements (13 strong recommendations) across 17 PICO questions. Major changes from prior versions include a strong recommendation for DOACs over VKA as first-line treatment-phase therapy, a strong recommendation for oral Xa inhibitors over LMWH in cancer-associated thrombosis, new guidance on antiphospholipid syndrome favoring VKA over DOACs, and endorsement of reduced-dose DOACs for extended-phase therapy. Anticoagulation phases are formally defined as initiation (5-21 days), treatment (3 months), and extended (no preplanned stop date).

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