TY - JOUR
T1 - Risk models for VTE and bleeding in medical inpatients
T2 - Systematic identification and expert assessment
AU - Darzi, Andrea J.
AU - Karam, Samer G.
AU - Spencer, Frederick A.
AU - Spyropoulos, Alex C.
AU - Mbuagbaw, Lawrence
AU - Woller, Scott C.
AU - Zakai, Neil A.
AU - Streiff, Michael B.
AU - Gould, Michael K.
AU - Cushman, Mary
AU - Charide, Rana
AU - Etxeandia-Ikobaltzeta, Itziar
AU - Germini, Federico
AU - Rigoni, Marta
AU - Agarwal, Arnav
AU - Morsi, Rami Z.
AU - Akl, Elie A.
AU - Iorio, Alfonso
AU - Schünemann, Holger J.
N1 - Publisher Copyright:
© 2020 by The American Society of Hematology.
PY - 2020/6/23
Y1 - 2020/6/23
N2 - Risk assessment models (RAMs) for venous thromboembolism (VTE) and bleeding in hospitalized medical patients inform appropriate use of thromboprophylaxis. Our aim was to use a novel approach for selecting risk factors for VTE and bleeding to be included in RAMs. First, we used the results of a systematic review of all candidate factors. Second, we used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of the evidence for the identified factors. Third, we using a structured approach to select factors to develop the RAMs, by building on clinical and methodological expertise. The expert panel made judgments on whether to include, potentially include, or exclude risk factors, according to domains of the GRADE approach and the Delphi method. The VTE RAM included age >60 years, previous VTE, acute infections, immobility, acute paresis, active malignancy, critical illness, and known thrombophilia. The bleeding RAM included age ≥65 years, renal failure, thrombocytopenia, active gastroduodenal ulcers, hepatic disease, recent bleeding, and critical illness. We identified acute infection as a factor that was not considered in widely used RAMs. Also, we identified factors that require further research to confirm or refute their importance in a VTE RAM (eg, D-dimer). We excluded autoimmune disease which is included in the IMPROVE (International Medical Prevention Registry on Venous Thromboembolism) bleeding RAM. Our results also suggest that sex, malignancy, and use of central venous catheters (factors in the IMPROVE bleeding RAM) require further research. In conclusion, our study presents a novel approach to systematically identifying and assessing risk factors to be included or further explored during RAM development.
AB - Risk assessment models (RAMs) for venous thromboembolism (VTE) and bleeding in hospitalized medical patients inform appropriate use of thromboprophylaxis. Our aim was to use a novel approach for selecting risk factors for VTE and bleeding to be included in RAMs. First, we used the results of a systematic review of all candidate factors. Second, we used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of the evidence for the identified factors. Third, we using a structured approach to select factors to develop the RAMs, by building on clinical and methodological expertise. The expert panel made judgments on whether to include, potentially include, or exclude risk factors, according to domains of the GRADE approach and the Delphi method. The VTE RAM included age >60 years, previous VTE, acute infections, immobility, acute paresis, active malignancy, critical illness, and known thrombophilia. The bleeding RAM included age ≥65 years, renal failure, thrombocytopenia, active gastroduodenal ulcers, hepatic disease, recent bleeding, and critical illness. We identified acute infection as a factor that was not considered in widely used RAMs. Also, we identified factors that require further research to confirm or refute their importance in a VTE RAM (eg, D-dimer). We excluded autoimmune disease which is included in the IMPROVE (International Medical Prevention Registry on Venous Thromboembolism) bleeding RAM. Our results also suggest that sex, malignancy, and use of central venous catheters (factors in the IMPROVE bleeding RAM) require further research. In conclusion, our study presents a novel approach to systematically identifying and assessing risk factors to be included or further explored during RAM development.
UR - http://www.scopus.com/inward/record.url?scp=85088289098&partnerID=8YFLogxK
U2 - 10.1182/bloodadvances.2020001937
DO - 10.1182/bloodadvances.2020001937
M3 - Article
C2 - 32542391
AN - SCOPUS:85088289098
SN - 2473-9529
VL - 4
SP - 2557
EP - 2566
JO - Blood advances
JF - Blood advances
IS - 12
ER -