Methodology for adaptation of the ASH Guidelines for Management of Venous Thromboembolism for the Latin American context

Abstract

Background: From 2017 to 2020, the American Society of Hematology (ASH) collaborated with 12 hematology societies in Latin America to adapt the ASH guidelines on venous thromboembolism (VTE). Objective: To describe the methods used to adapt the ASH guidelines on venous thromboembolism. Methods: Each society nominated 1 individual to serve on the guideline panel. The work of the panel was facilitated by the 2 methodologists. The methods team selected 4 of the original VTE guidelines for a first round. To select the most relevant questions, a 2-step prioritization process was conducted through an on-line survey and then through in-person discussion. During an in-person meeting in Rio de Janeiro, Brazil, from 23 April through 26 April 2018, the panel developed recommendations using the ADOLOPMENT approach. Evidence about health effects from the original guidelines was reused, but important data about resource use, accessibility, feasibility, and impact in health equity were added. Results: In the guideline accompanying this paper, Latin American panelists selected 17 questions from an original pool of 49. Of the 17 questions addressed, substantial changes were introduced for 5 recommendations, and remarks were added or modified for 12 recommendations. Conclusions: By using the evidence from an international guideline, a significant amount of work and time were saved; by adding regional evidence, the final recommendations were tailored to the Latin American context. This experience offers an alternative to develop guidelines relevant to local contexts through a global collaboration.

American Society of Hematology, ABHH, ACHO, Grupo CAHT, Grupo CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Panameña de Hematología, Sociedad Peruana de Hematología, and SVH 2022 guidelines for prevention of venous thromboembolism in surgical and medical patients and long-distance travelers in Latin America

“…2 The GRADE ADOLOPMENT process and the detailed methods used in this effort are described elsewhere. 25…”

American Society of Hematology, ABHH, ACHO, Grupo CAHT, Grupo CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Panamena de Hematología, Sociedad Peruana de Hematología, and SVH 2023 guidelines for diagnosis of venous thromboembolism and for its management in special populations in Latin America

“…The Latin American panel unanimously agreed that all or almost all women with a previous VTE event and high risk of recurrence or related with estrogen exposure will be better off with anticoagulation. However, the ASH-GRADE rules specified in our methods 9 prevented a strong recommendation in the context of low certainty of evidence regarding the benefits of prophylaxis (i.e., uncertain benefit). Additionally, the Latin American panel noted that most of the women at low risk of recurrence place a higher value in preventing a new VTE event than in the daily injections of LMWH, and thus prefer to receive prophylaxis.…”

“…The ASH GRADE rules specified in our methods prevent a strong recommendation in such situations. 9 In addition, some women in the region may have significant barriers to accessing adequate follow-up and treatment.…”

Review of an international pilot project to adapt the Canadian Adult Obesity Clinical Practice Guideline

“…Organizations and individuals in several countries immediately expressed an interest in endorsing and/or adapting the guideline for use in their jurisdictions given the extensive human, financial and technical resources required to create a de novo CPG. However, while guidelines in other chronic disease spaces such as lung cancer, psychosis, and rheumatology [ [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] ] have successfully demonstrated adaptation from one country to another, an adaptation of an obesity CPG had, to our knowledge, never been implemented.…”