What’s New in the Guidelines Last Updated: May 31, 2022 The Coronavirus Disease 2019 (COVID-19) Treatment Guidelines is published in an electronic format that can be updated in step with the rapid pace and growing volume of information regarding the treatment of COVID-19. The COVID-19 Treatment Guidelines Panel (the Panel) is committed to updating this document to ensure that health care providers, patients, and policy experts have the most recent information regarding the optimal management of COVID-19 (see the Panel Roster for a list of Panel members). New Guidelines sections and recommendations and updates to existing Guidelines sections are developed by working groups of Panel members. All recommendations included in the Guidelines are endorsed by a majority of Panel members (see Guidelines Development for additional details on the development process). Major revisions to the Guidelines within the past month are as follows: May 31, 2022 Critical Care for Children Four new sections were added to the Guidelines to discuss the unique aspects of managing critically ill children with COVID-19 or multisystem inflammatory syndrome in children (MIS-C). The new sections are: • Introduction to Critical Care Management of Children With COVID-19 • Extracorporeal Membrane Oxygenation for Children • Hemodynamic Considerations for Children • Oxygenation and Ventilation for Children Antithrombotic Therapy in Patients With COVID-19 Since the last update, the results from several large randomized controlled trials that evaluated the use of antiplatelet therapy in hospitalized patients with COVID-19 have been published. Additionally, a randomized controlled trial evaluated a 35-day course of rivaroxaban after hospital discharge in patients with COVID-19 who were at risk of experiencing thromboembolic events. After reviewing the results of these studies, the Panel provides the following recommendations: • The Panel recommends against the use of antiplatelet therapy to prevent COVID-19 progression or death in noncritically ill patients (BIIa). • There is insufficient evidence for the Panel to recommend either for or against antiplatelet therapy in critically ill patients with COVID-19. • The Panel recommends against routinely continuing venous thromboembolism (VTE) prophylaxis for patients with COVID-19 after hospital discharge, except in a clinical trial (AIII). • For patients who are at high risk for VTE and low risk for bleeding, there is insufficient evidence to recommend either for or against continuing anticoagulation after hospital discharge unless another indication for VTE prophylaxis exists. Downloaded from https://www.covid19treatmentguidelines.nih.gov/ on 7/6/2022 COVID-19 Treatment Guidelines 6 The rationale for the Panel’s recommendations is discussed in this section. A new table summarizes the data from randomized controlled trials that evaluated the use of antiplatelet therapy in hospitalized patients with COVID-19. Critical Care for Adults The Panel made a number of updates to these sections, including: • The rationale in Oxygenation and Ventilation for Adults was revised to include data from recent clinical trials. • The Panel updated the recommendations and rationale for empiric broad-spectrum antibiotics in Pharmacologic Interventions for Critically Ill Patients. • The Infection Control and Acute Kidney Injury and Renal Replacement Therapy sections have been archived. Corticosteroids The rationale in this section and the information in Table 4a incorporate new data from clinical trials, including trials that investigated different doses of dexamethasone for the treatment of COVID-19. Colchicine This section includes results from the COLCOVID trial, an open-label, multicenter, randomized trial that evaluated the use of colchicine in hospitalized adults with COVID-19. After reviewing the results of the trial, the Panel continues to recommend against the use of colchicine for the treatment of hospitalized patients with COVID-19 (AI). Special Considerations in Adults and Children With Cancer The Panel updated the information on the use of COVID-19 vaccines in patients with cancer and their close contacts. This section also discusses using tixagevimab plus cilgavimab (Evusheld) as pre-exposure prophylaxis (PrEP) in these patients and the potential drug-drug interactions between ritonavir-boosted nirmatrelvir (Paxlovid) and certain chemotherapeutic agents. Special Considerations in Solid Organ Transplant, Hematopoietic Stem Cell Transplant, and Cellular Immunotherapy Candidates, Donors, and Recipients The Panel added COVID-19 vaccination recommendations for potential organ and stem cell donors, and for close contacts of transplant and cellular immunotherapy candidates and recipients. This section also discusses using tixagevimab plus cilgavimab as PrEP in transplant candidates and