Cited by 636Venous Thromboembolism Diagnosis and ManagementBlood Coagulation and Thrombosis MechanismsCerebral Venous Sinus Thrombosis

American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy

Open access
Bates, Shannon M., Rajasekhar, Anita, Middeldorp, Saskia, McLintock, Claire, Rodger, Marc A., James, Andra H., Vazquez, Sara R., Greer, Ian A. +6 more·2018·Blood Advances

Abstract

BACKGROUND: Venous thromboembolism (VTE) complicates ∼1.2 of every 1000 deliveries. Despite these low absolute risks, pregnancy-associated VTE is a leading cause of maternal morbidity and mortality. OBJECTIVE: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and others in decisions about the prevention and management of pregnancy-associated VTE. METHODS: ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations. RESULTS: The panel agreed on 31 recommendations related to the treatment of VTE and superficial vein thrombosis, diagnosis of VTE, and thrombosis prophylaxis. CONCLUSIONS: There was a strong recommendation for low-molecular-weight heparin (LWMH) over unfractionated heparin for acute VTE. Most recommendations were conditional, including those for either twice-per-day or once-per-day LMWH dosing for the treatment of acute VTE and initial outpatient therapy over hospital admission with low-risk acute VTE, as well as against routine anti-factor Xa (FXa) monitoring to guide dosing with LMWH for VTE treatment. There was a strong recommendation (low certainty in evidence) for antepartum anticoagulant prophylaxis with a history of unprovoked or hormonally associated VTE and a conditional recommendation against antepartum anticoagulant prophylaxis with prior VTE associated with a resolved nonhormonal provoking risk factor.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1182/bloodadvances.2018024802

Cites

237 of 237 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The ASH 2018 guidelines strongly recommend both antepartum and postpartum thromboprophylaxis in women with prior VTE related to high estrogen states, based on low-certainty evidence.

    “The ASH 2018 guidelines strongly recommend both antepartum and postpartum thromboprophylaxis in these patients, although this is based on low-certainty evidence [109].”

    From Estrogen and thrombosis: a bench to bedside review (2020) · cites this paper as [109]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

3 of the 240 references couldn’t be matched to a known paper.

Research works printed but not linked: 9

  1. Knight M, Nair M, Tuffnell D, Kenyon S, Shakespeare J, Brocklehurst P, Kurinczuk JJ (eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers' Care -Surveillance of maternal deaths in the UK 2012-14 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-14. Oxford, United Kingdom: National Perinatal Epidemiology Unit, University of Oxford; 2016.
  2. Greenfield S, Mancher M, Wolman DM, et al. Clinical practice guidelines we can trust. Washington, DC: National Academies Press; 2011.
  3. Langer G, Meerpohl JJ, Perleth M, Gartlehner G, Kaminski-Hartenthaler A, Sch ünemann H. GRADE guidelines: 1. Introduction -GRADE evidence profiles and summary of findings tables [in German]. Z Evid Fortbild Qual Gesundhwes. 2012;106(5):357-368.
  4. Lo B, Fields, M. Conflict of Interest in Medical Research, Education, and Practice. Washington, DC: National Academies Press; 2009.
  5. Sch ünemann HJ, Mustafa R, Brozek J, et al; GRADE Working Group. GRADE Guidelines: 16. GRADE evidence to decision frameworks for tests in clinical practice and public health. J Clin Epidemiol. 2016;76:89-98.
  6. Alonso-Coello P, Oxman AD, Moberg J, et al; GRADE Working Group. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines. BMJ. 2016;353:i20899.
  7. Hassouna A, Allam H. Anticoagulation of pregnant women with mechanical heart valve prosthesis: a systematic review of the literature (2000-2009). J Coagul Disord. 2010;2:81-88.
  8. Du GC, Zhang MC, Zhao JC. Catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of proximal deep vein thrombosis-a meta-analysis. Vasa. 2015;44(3):195-202.
  9. Krishnamurthy P, Martin CB, Kay HH, et al. Catheter-directed thrombolysis for thromboembolic disease during pregnancy: a viable option. J Matern Fetal Med. 1999;8(1):24-27.

Cited by

Sorted by citations

Authors
Bates, S. M., Rajasekhar, A., Middeldorp, S., McLintock, C., Rodger, M. A., James, A. H., Vazquez, S. R., Greer, I. A., Riva, J. J., Bhatt, M., Schwab, N., Barrett, D., LaHaye, A., & Rochwerg, B.
Affiliations
  • Thrombosis and Atherosclerosis Research Institute (CA)
  • University of Florida Health (US)
  • Amsterdam UMC Location University of Amsterdam (NL)
  • Auckland City Hospital (NZ)
  • University of Ottawa (CA)
  • Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, NC;
  • University of Utah (US)
  • Queen's University Belfast (GB)
  • McMaster University (CA)
  • University of Toronto (CA)
  • Wake Forest University (US)
  • Alexandria, VA; and
Venue
Blood Advances
Published
2018-11-27
Volume
2
Issue
22
Pages
3317-3359
ISSN
  • 2473-9529 (ISSN-L)
  • 2473-9537
OpenAlex
W2903022860
Cited by
625
References
240
Citations by year
2026: 94 · 2025: 89 · 2024: 90 · 2023: 79 · 2022: 81 · 2021: 86 · 2020: 70 · 2019: 33 · 2018: 2 · 2016: 1
FWCI
45.21
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Blood Advances (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Pure Amsterdam UMC (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
  • Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
  • Health Sciences › Medicine › Neurology › Cerebral Venous Sinus Thrombosis
Keywords
venous thromboembolism, pregnancy, thromboprophylaxis, low molecular weight heparin, unfractionated heparin, anti-factor Xa monitoring, superficial thrombophlebitis, VTE diagnosis, maternal morbidity, anticoagulant dosing
MeSH terms
Administration, Oral, Anticoagulants, Breast Feeding, Female, Fibrinolytic Agents, Heparin, Low-Molecular-Weight, Humans, Infant, Infant, Newborn, Pregnancy, Evidence-Based Medicine, Venous Thromboembolism

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review