News Release

The AABB releases clinical practice guidelines for the appropriate use of COVID-19 convalescent plasma

Embargoed news from Annals of Internal Medicine

Peer-Reviewed Publication

American College of Physicians

1. The AABB releases clinical practice guidelines for the appropriate use of COVID-19 convalescent plasma
Abstract: https://www.acpjournals.org/doi/10.7326/M22-1079
Editorial: https://www.acpjournals.org/doi/10.7326/M22-2329
URLs go live when the embargo lifts
The Association for the Advancement of Blood and Biotherapies (AABB) has released clinical practice guidelines for the appropriate use of COVID-19 convalescent plasma (CCP) in hospital and outpatient settings. Based on two living systematic reviews of randomized controlled trials (RCTs), the guidelines provide five specific recommendations for treating patients with COVID-19 and suggest that CCP is most effective when transfused with high neutralizing titers to infected patients early after symptom onset. The guidelines are published in Annals of Internal Medicine.

COVID-19 convalescent plasma (CCP) has emerged as a potential treatment of COVID-19. However, meta-analysis data and recommendations are limited. A team lead by AABB’s Clinical Transfusion Medicine committee studied published research to inform the guidelines. The two living systematic reviews of RCTs evaluating CCP from 1 January 2019 to 26 January 2022 comprised 33 RCTs assessing 21,916 participants.

Based on the data, the AABB recommends that nonhospitalized patients at high risk for disease progression should have CCP transfusion in addition to the usual standard of care. The AABB also recommends against CCP transfusion in hospitalized patients with moderate or severe disease but says that CCP transfusion should be added to usual standard of care for those who do not have SARS CoV-2 antibodies detected at admission and for those with preexisting immunosuppression. The AABB recommends against prophylactic CCP transfusion for uninfected persons with close contact exposure to a person with COVID-19. The AABB summarized their findings with a good clinical practice statement: CCP is most effective when transfused with high neutralizing titers early after symptom onset.

Researchers summarized results using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. Recommendations were made under the assumption that patients would highly value avoiding risks for disease progression, morbidity, and mortality from COVID-19. Thus, when the data suggested that there was limited harm from CCP transfusions and that there was benefit to CCP, the panel was prepared to make recommendations for CCP.

The authors say there are several advantages of CCP. While SARS-CoV-2 evolves and new variants of concern (VOCs) emerge that may evade monoclonal antibodies, high-titer CCP continues to be effective. CCP is also relatively easy to collect, making it a less expensive therapeutic option than other passive antibody therapies.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Aaron A.R. Tobian, MD, PhD, please contact Julia Zimmerman at jzimmerman@aabb.org.
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2. Decision model favors left atrial appendage occlusion over oral anticoagulants for stroke prevention in patients at highest risk for bleeding
Abstract: https://www.acpjournals.org/doi/10.7326/M21-4653
Editorial: https://www.acpjournals.org/doi/10.7326/M22-2271
Free summary: https://www.acpjournals.org/doi/10.7326/P22-0015
URL goes live when the embargo lifts
A decision model found that the relative clinical benefit of left atrial appendage occlusion (LAAO) and oral anticoagulants (OAC) in patients with atrial fibrillation depends on the patients' baseline risks for stroke and bleeding. LAAOs were found to be the preferred strategy in those with the highest bleeding risk. This benefit became less certain with increasing risk for ischemic stroke and decreasing bleeding risk. The findings are published in Annals of Internal Medicine.

LAAO is a potential alternative to OAC in selected patients with atrial fibrillation. Compared with anticoagulants, LAAO decreases major bleeding risk, but concerns remain over the possible increased risk of ischemic stroke.

Researchers from the Libin Cardiovascular Institute, University of Calgary and the Duke Clinical Research Institute, Duke University used a decision-analytic model to simulate a virtual clinical trial of stroke prevention strategies in a cohort of elderly individuals with AF and without prior stroke to better understand the risk–benefit tradeoffs when choosing between LAAO and OACs contingent on a patient's stroke risk and bleeding risk. The primary end point was clinical benefit measured in quality adjusted life-years, and the secondary end points were life expectancy or life-years and net clinical benefit. The researchers found that the clinical benefit of LAAO over OACs depends on the patient-specific baseline risk for stroke and bleeding. Although LAAOs were favorable among patients with the highest bleeding risk, that benefit became less certain at higher stroke risk. According to the researchers, these findings may help to inform shared decision making when selecting patients for LAAO.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. For an interview with lead author Derek S. Chew, MD, MSc, please contact Kyle Marr at kyle.marr@ucalgary.ca.
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