COVID-19 and the associated thromboembolic problems affect a large number of people worldwide and is a relevant health problem. Fortunately, the pandemic has led to considerable research efforts that are now available. The section on vaccine-induced thrombocytopenia (VITT) is particularly helpful.

These latest recommendations incorporating newer evidence regarding anticoagulation in COVID-19 patients are more streamlined and aid providers in making appropriate choices. It also includes guidance on testing for VITT, which is very helpful.

Excellent review. I loved that the guideline writers mentioned the new RCTs that led them to update the guidelines. Very relevant for day-to-day practice and will definitely help me in deciding the treatment course for patients.

This updated ISTH Guideline seemingly provides greater authority to their recommendations on preventing TE in patients with COVID-19. Unfortunately, however, we do not know whether the findings of the many earlier RCTs (done when the predominant SARS-CoV-2 strains were much more virulent and very few patients had partial immunity from previous infection or the COVID-19 vaccine when they presented) are relevant to the contemporary world where the circulating variants are intrinsically far less virulent (and may be less capable of precipitating TE). Also, most newly infected patients have partial immunity when they present (and may be intrinsically much less vulnerable to COVID-19-induced TE).

This guideline is quite useful because of its direct and clear recommendations that were updated after a thorough review of the current literature. Particularly interesting is the recommendation to use therapeutic-dose heparin in “selected” non-critically ill hospitalized patients because it seems to improve survival. However, it would be useful to define more accurately which patients will benefit from this measure (i.e., to clarify the characteristics of those “selected” patients). For example, I would like to known whether the expert panel members agree with the NIH guideline recommendation to limit therapeutic-dose heparin to non-critically hospitalized patients who need supplemental oxygen and have high D-dimer levels without an increased risk for bleeding.

In this guideline, updates to recommendations for anticoagulation and COVID were given. Full dose versus prophylactic dose anticoagulation is apparently preferred for non-ICU inpatients. The recommendations for diagnosing VITT using PF4 antibodies are also listed. This probably matters to hospitalists, but not as much because we are now seeing patients who are less sick.

Authoritative review of the literature with updated guidelines. Should be the standard reference.