The ASH ISTH NHF WFH VWD Guideline Development Process
ASH in collaboration with the International Society on Thrombosis and Haemostasis (ISTH), the National Hemophilia Foundation (NHF), and the World Federation of Hemophilia (WFH) brought together two panels that prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Outcomes and Implementation Research Unit at the University of Kansas Medical Center, under contract, conducted systematic evidence reviews for each prioritized question.
Each panel includes U.S. and international experts, as well as experts from multiple disciplines including hematology, obstetric medicine, nephrology, and guideline development. The ASH ISTH NHF WFH VWD Diagnosis panel includes 4 patient representatives and the ASH ISTH NHF WFH VWD Management panel includes 3 patient representatives, who participates equally with all other experts throughout the guideline development process.
Development of these guidelines was wholly funded by the four collaborating organizations ASH, ISTH, NHF, and WFH. Before and during appointment to the panel, individuals disclose both financial and nonfinancial interests. Conflicts of interest are managed through panel composition, disclosure, and recusal.
Once formed, each panel conducted a brainstorming exercise to develop a list of clinical questions and outcomes of interest. In addition, the collaborating organizations conducted an international survey that helped prioritized topics. Outcomes of interest rated highly by the panel and those identified as important based on the literature reviews are further refined.
Researchers then conducted systematic reviews of intervention effects and searched for evidence related to baseline risks, values, preferences, and costs. Panels then develop recommendations after summarizing findings within the GRADE Evidence-to-Decision (EtD) framework.
Draft recommendations were made available online for external review by stakeholders including allied organizations, other medical professionals, patients, and the public. The final manuscript was revised to address pertinent comments, but no changes were made to recommendations.
Once the panels considered the guidelines complete, they were reviewed by the ASH Executive Committee, which provided approval for the guidelines to be submitted for peer review and subsequent publication.