Evidence map›Paper›PMID 35167861›Full record

GuidelineChest2022

Thromboprophylaxis in Patients With COVID-19: A Brief Update to the CHEST Guideline and Expert Panel Report.

Lisa K Moores, Tobias Tritschler, Shari Brosnahan, Marc Carrier, Jacob F Collen, Kevin Doerschug, Aaron B Holley, Jonathan Iaccarino, David Jimenez, Gregoire LeGal and 2 more

Erratum issuedOpen access · bronzeAbstract readMeta-AnalysisPractice Guideline
PubMed Full text at PMC Publisher
In one paragraph

Guideline in Chest, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 53 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
53citing papers in PubMed, 2 pooled it
10.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

53 citing papers in PubMed, 2 syntheses or guidelines pooled it, 102 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Trial
  4. Trial
  5. Review
  6. Review
  7. Article
  8. Article
  9. Article
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  11. Article
  12. Article
  13. Article
  14. COVID-19: a vascular nightmare unfolding.Frontiers in immunology · 2025
    Review
  15. Review
  16. Article
  17. Observational
  18. Article
  19. Review
  20. COVID-19-associated venous thromboembolism: risk of recurrence and major bleeding.Research and practice in thrombosis and haemostasis · 2023
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 10 institutions in 4 countries.

Lisa K MooresDepartment of Medicine, F. Edward Hebert School of Medicine at the Uniformed Services University of the Health Sciences, Bethesda, MD. Electronic address: lisa.moores@usuhs.edu.
Tobias TritschlerDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Shari BrosnahanDivision of Pulmonary, Critical Care, and Sleep Medicine, New York University Langone Health System, New York, NY.
Marc CarrierDepartment of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
Jacob F CollenDepartment of Medicine, F. Edward Hebert School of Medicine at the Uniformed Services University of the Health Sciences, Bethesda, MD; Pulmonary, Critical Care and Sleep Medicine Service, Walter Reed National Military Medical Center, Bethesda, MD.
Kevin DoerschugPulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, IA.
Aaron B HolleyPulmonary, Critical Care and Sleep Medicine Service, Walter Reed National Military Medical Center, Bethesda, MD.
Jonathan IaccarinoAmerican College of Chest Physicians, Glenview, IL; The Pulmonary Center, Boston University School of Medicine, Boston, MA.
David JimenezRespiratory Medicine, Ramón y Cajal Hospital (IRYCIS), Madrid, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain.
Gregoire LeGalDepartment of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
Parth RaliDepartment of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA.
Philip WellsDepartment of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
Ottawa Hospital · CAUniformed Services University of the Health Sciences · USBoston University · USCentro de Investigación Biomédica en Red de Enfermedades Respiratorias · ESNYU Langone Health · USTemple University · USUniversity of Bern · CHUniversity of Iowa · USUniversity of Ottawa · CAWalter Reed National Military Medical Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPatients hospitalized with COVID-19 often exhibit markers of a hypercoagulable state and have an increased incidence of VTE. In response, CHEST issued rapid clinical guidance regarding prevention of VTE. Over the past 18 months the quality of the evidence has improved. We thus sought to incorporate this evidence and update our recommendations as necessary. STUDY DESIGN AND

methodsThis update focuses on the optimal approach to thromboprophylaxis in hospitalized patients. The original questions were used to guide the search, using MEDLINE via PubMed. Eight randomized controlled trials and one observational study were included. Meta-analysis, using a random effects model, was performed. The panel created summaries using the GRADE Evidence-to-Decision framework. Updated guidance statements were drafted, and a modified Delphi approach was used to obtain consensus.

resultsWe provide separate guidance statements for VTE prevention for hospitalized patients with acute (moderate) illness and critically ill patients in the ICU. However, we divided each original question and resulting recommendation into two questions: standard prophylaxis vs therapeutic (or escalated dose) prophylaxis and standard prophylaxis vs intermediate dose prophylaxis. This led to a change in one recommendation, and an upgrading of three additional recommendations based upon higher quality evidence.

conclusionsAdvances in care for patients with COVID-19 have improved overall outcomes. Despite this, rates of VTE in these patients remain elevated. Critically ill patients should receive standard thromboprophylaxis for VTE, and moderately ill patients with a low bleeding risk might benefit from therapeutic heparin. We see no role for intermediate dose thromboprophylaxis in either setting.

Indexed as

COVID-19Venous ThromboembolismAnticoagulantsCritical IllnessHeparinHumansObservational Studies as TopicAnticoagulantsHeparinCOVID-19DICDVThypercoagulabilitypulmonary embolismVTE

Identifiers

PMID35167861
PMCPMC8839802
OpenAlexW4210989196

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.