PRACTICE UPDATE
American Society of Hematology’s Guidelines for
Venous Thromboembolism and von Willebrand Disease
In 2018, the American Society of Hematology (ASH) has
continued its efforts to develop and publish evidence-based
clinical practice guidelines to help practicing hematologists
and other clinicians improve the quality of care for patients
with various hematologic conditions. Here, we update read-
ers on the status of ASH Clinical Practice Guidelines for two
nonmalignant hematologic conditions: venous thrombo-
embolism (VTE) and von Willebrand disease (VWD).
Venous Thromboembolism
In November 2015, ASH and the McMaster University GRADE
Center announced a collaboration to develop clinical practice
guidelines on the diagnosis and treatment of VTE – a commonly
encountered clinical concern for hematologists and for other
medical specialties and disciplines. ASH is the sponsoring orga-
nization providing all funding for the work, while the GRADE
Center has offered expertise in systematic evidence review and
guideline development methods. This project represents the first
large-scale guideline development effort by ASH, undertaken as
part of a larger Quality Initiative approved by the Society in 2014.
“We are very excited about all of these topics,” said Adam
Cuker, MD, MS, chair of the ASH VTE Guideline Coordination
Panel and director of the Penn Comprehensive and Hemophilia
Thrombosis Program at the University of Pennsylvania. He noted
that the Society is devoted to ensuring that the methodology
of the VTE guidelines are as rigorous as possible. “Collectively,
they will include more than 200 questions and involve more
than 100 experts on VTE from around the world, as well as
expert methodologists and patient representatives.”
The VTE clinical practice guidelines will focus on 10 areas:
• prevention of VTE in surgical patients
• prevention of VTE in nonsurgical patients
• diagnosis of VTE
• thrombophilia
• treatment of VTE (deep vein thrombosis and pulmonary
embolism)
• optimal management of anticoagulation therapy
• heparin-induced thrombocytopenia
• prevention and treatment of VTE in patients with cancer
• VTE in the context of pregnancy
• VTE in pediatric populations
Dr. Cuker noted that, as of fall 2018, several of the guideline chap-
ters had been submitted for publication and are expected to be
published in advance of the ASH annual meeting in December. In
addition, the Society is developing a number of tools and resources
to support their dissemination and implementation.
All stakeholders share the continued goal of creating guide-
lines that “meet the highest standards for rigor and credibility,
that would be useful for and used by clinicians and – most
important – that would improve the quality of care received by
our patients,” said Holger Schünemann, MD, PhD, MSc, chair
of the Department of Health Research Methods, Evidence, and
Impact at McMaster University in Ontario.
“We are very excited about this effort,” Dr. Cuker added. “We
see it as truly a comprehensive guideline on VTE – a very com-
mon disease – and are hopeful that it will be useful to clinicians
and, ultimately, will help improve outcomes for our patients.”
von Willebrand Disease
In June 2018, ASH announced that it will be collaborating with
the International Society on Thrombosis and Haemostasis
(ISTH), the National Hemophilia Foundation (NHF), the World
Federation of Hemophilia (WFH), and the University of Kansas
(KU) Medical Center to develop clinical practice guidelines on
the diagnosis and management of VWD.
Although VWD is considered a rare disease, it is the most
common inherited bleeding disorder, affecting approximately
one percent of the world’s population. Symptoms may vary from
patient to patient – or in a single patient over the course of his or
her life – and this complex clinical presentation makes diagnosis
challenging for hematologists and referring physicians.
“These guidelines will provide clinicians and patients with
clear recommendations for the timely diagnosis of VWD and
appropriate management of symptoms,” said ASH President
Alexis A. Thompson, MD, MPH, of Ann & Robert H. Lurie
Children’s Hospital of Chicago, in a press release. “ASH is
pleased to collaborate with ISTH, NHF, and WFH to convene
diverse expert panels and expand the reach of the guidelines
across the globe.”
To create and maintain these state-of-the-art guidelines, two
expert panels will produce recommendations for VWD diagnosis
and management. The panels comprise more than 20 individuals,
including U.S.-based and international hematologists, patients
with VWD, and scientists with expertise in evidence synthesis and
appraisal and guideline development methodology.
Panel members will identify and prioritize guideline questions
based on the fr equency with which a question arises in clinical
practice, the degree to which there is variation in clinical practice,
the extent to which the question has already been addressed by
high-quality guidelines, and implications for resource use.
Once the questions are formed, researchers at KU Medical
Center will conduct a systematic review of available evidence,
from which clinical recommendations will be developed. As
with ASH’s other clinical practice guidelines in development, a
public comment period will follow.
The publication of the guidelines is anticipated in 2020, with
tools and resources provided to help clinicians implement the
recommended guidelines. ●
October 2018
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