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Risk-assessment models for VTE and bleeding in hospitalized medical patients: an overview of systematic reviews
Darzi AJ, Repp AB, Spencer FA, Morsi RZ, Charide R, Etxeandia-Ikobaltzeta I, Bauer KA, Burnett AE, Cushman M, Dentali F, et al
Blood advances. 2020;4(19):4929-4944
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Abstract
Multiple risk-assessment models (RAMs) for venous thromboembolism (VTE) in hospitalized medical patients have been developed. To inform the 2018 American Society of Hematology (ASH) guidelines on VTE, we conducted an overview of systematic reviews to identify and summarize evidence related to RAMs for VTE and bleeding in medical inpatients. We searched Epistemonikos, the Cochrane Database, Medline, and Embase from 2005 through June 2017 and then updated the search in January 2020 to identify systematic reviews that included RAMs for VTE and bleeding in medical inpatients. We conducted study selection, data abstraction and quality assessment (using the Risk of Bias in Systematic Reviews [ROBIS] tool) independently and in duplicate. We described the characteristics of the reviews and their included studies, and compared the identified RAMs using narrative synthesis. Of 15 348 citations, we included 2 systematic reviews, of which 1 had low risk of bias. The reviews included 19 unique studies reporting on 15 RAMs. Seven of the RAMs were derived using individual patient data in which risk factors were included based on their predictive ability in a regression analysis. The other 8 RAMs were empirically developed using consensus approaches, risk factors identified from a literature review, and clinical expertise. The RAMs that have been externally validated include the Caprini, Geneva, IMPROVE, Kucher, and Padua RAMs. The Padua, Geneva, and Kucher RAMs have been evaluated in impact studies that reported an increase in appropriate VTE prophylaxis rates. Our findings informed the ASH guidelines. They also aim to guide health care practitioners in their decision-making processes regarding appropriate individual prophylactic management.
PICO Summary
Population
Adult patients hospitalized for an acute, critical, or chronic medical illness. (2 systematic reviews).
Intervention
Overview of systematic reviews to identify and describe multiple risk-assessment models (RAMs) and their clinical utility for venous thromboembolism (VTE) and bleeding.
Comparison
Standard care without the use of RAMs or a different RAM from the one used in the intervention.
Outcome
Fifteen unique RAMs for VTE were identified, seven were derived from individual participant data and eight were developed empirically using consensus approaches, risk factors identified from a literature review, and clinical expertise. Five systematic reviews described RAMs that have been externally validated and three systematic reviews described RAMs evaluated in terms of thromboprophylaxis rates or clinical outcomes.