Oh, joy! The International Society on Thrombosis and Haemostasis (ISTH) has graced us with an update to their 2022 antithrombotic treatment guidelines for COVID-19, because, apparently, the pandemic decided to throw us a curveball with 16 new randomized controlled trials. Who would have thought that a global health crisis would continue to evolve? Shocking, I know. So, in a stunning display of adaptability, the ISTH decided it was time to revamp their recommendations, because, well, science.

Using the oh-so-reliable American College of Cardiology Foundation/American Heart Association methodology for assessing the level of evidence (LOE) and class of recommendation (COR), they’ve managed to upgrade five recommendations to the gold standard LOE A. And hold your applause, because they didn’t stop there—they added two new recommendations for antithrombotic treatment in COVID-19 patients. Because more is always better, right?

But wait, there’s more! They’ve also tackled the hot topic of COVID-19 vaccination and the rare, but media-beloved, vaccine-induced immune thrombotic thrombocytopenia (VITT). Only the crème de la crème of evidence made it into their recommendations, with LOE A or B being the ticket to entry. The panelists, in a miraculous feat of agreement, settled on 19 recommendations, neatly packaged for various patient scenarios, including the nonhospitalized, the noncritically ill hospitalized, the critically ill hospitalized, and even those lucky enough to be discharged. And because they’re all about inclusivity, they’ve thrown in some advice on vaccination and VITT.

Among the highlights, a standing ovation was given for the strong recommendation (COR 1) for the use of prophylactic doses of low-molecular-weight heparin or unfractionated heparin in noncritically ill hospitalized patients. But wait, there’s a plot twist—for select VIP patients in this group, they recommend the blockbuster option of therapeutic-dose heparin. And for the grand finale, a strong recommendation against adding an antiplatelet agent in this patient group, because apparently, more isn’t always better.

So, there you have it, folks. The ISTH’s latest international guidelines, serving up recommendations for countries with a smorgasbord of healthcare resources and COVID-19 vaccine availability. Because nothing says global unity like updating medical guidelines during a pandemic.