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Meta-Analysis
. 2020 May 14;135(20):1788-1810.
doi: 10.1182/blood.2019003603.

Prognostic factors for VTE and bleeding in hospitalized medical patients: a systematic review and meta-analysis

Andrea J Darzi  1   2 , Samer G Karam  1   2 , Rana Charide  3 , Itziar Etxeandia-Ikobaltzeta  1   2 , Mary Cushman  4   5 , Michael K Gould  6 , Lawrence Mbuagbaw  1   2   7   8 , Frederick A Spencer  9 , Alex C Spyropoulos  10 , Michael B Streiff  11 , Scott Woller  12 , Neil A Zakai  4   5 , Federico Germini  1   2   9   13 , Marta Rigoni  14 , Arnav Agarwal  1   2   15 , Rami Z Morsi  3 , Alfonso Iorio  1   2   9 , Elie A Akl  1   2   3   16 , Holger J Schünemann  1   2   9
Affiliations
Meta-Analysis

Prognostic factors for VTE and bleeding in hospitalized medical patients: a systematic review and meta-analysis

Andrea J Darzi et al. Blood. .

Abstract

There may be many predictors of venous thromboembolism (VTE) and bleeding in hospitalized medical patients, but until now, systematic reviews and assessments of the certainty of the evidence have not been published. We conducted a systematic review to identify prognostic factors for VTE and bleeding in hospitalized medical patients and searched Medline and EMBASE from inception through May 2018. We considered studies that identified potential prognostic factors for VTE and bleeding in hospitalized adult medical patients. Reviewers extracted data in duplicate and independently and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. Of 69 410 citations, we included 17 studies in our analysis: 14 that reported on VTE, and 3 that reported on bleeding. For VTE, moderate-certainty evidence showed a probable association with older age; elevated C-reactive protein (CRP), D-dimer, and fibrinogen levels; tachycardia; thrombocytosis; leukocytosis; fever; leg edema; lower Barthel Index (BI) score; immobility; paresis; previous history of VTE; thrombophilia; malignancy; critical illness; and infections. For bleeding, moderate-certainty evidence showed a probable association with older age, sex, anemia, obesity, low hemoglobin, gastroduodenal ulcers, rehospitalization, critical illness, thrombocytopenia, blood dyscrasias, hepatic disease, renal failure, antithrombotic medication, and presence of a central venous catheter. Elevated CRP, a lower BI, a history of malignancy, and elevated heart rate are not included in most VTE risk assessment models. This study informs risk prediction in the management of hospitalized medical patients for VTE and bleeding; it also informs guidelines for VTE prevention and future research.

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Conflict of interest statement

Conflict-of-interest disclosure: A.J.D., I.E.-I., A.I., E.A.A., and H.J.S. are members of the GRADE working group. A.C.S. has received remuneration for consulting from Bayer, Janssen, and Portola and research support grants from Boehringer Ingelheim, Janssen, and the Center for Medicare and Medicaid Services. A.C.S. also reported an intellectual conflict as the lead in the group that derived and validated the IMPROVE tool for VTE risk assessment in hospitalized medical patients. M.B.S. has received remuneration for consulting for Bayer, Janssen, Pfizer, and Portola and research support grants from Boehringer-Ingelheim, Janssen, Portola, and Roche. M.C. is a former board member (2013-2017) of the American Heart Association and chaired the committee that produced the American Society of Hematology (ASH) 2018 Guidelines for Management of Venous Thromboembolism: Prophylaxis for Hospitalized and Nonhospitalized Medical Patients (ASH 2018 Guidelines for Management of VTE). F.A.S. and N.A.Z. reported participating as panel members for the ASH 2018 Guidelines for Management of VTE. N.A.Z. also reported receiving honoraria in 2017 from ASH for the Highlights of ASH 2017 presentation (Dallas, New York, and Latin America). H.J.S. was cochair of the ASH 2018 Guidelines for Management of VTE committee and procured grant funding from the CDC for this study. The remaining authors declare no competing financial interests.

Figures

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Graphical abstract
Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analysis flowchart.
See this image and copyright information in PMC

Comment in

  • A Magic 8-Ball for inpatient VTE?
    Samuelson Bannow BT. Samuelson Bannow BT. Blood. 2020 May 14;135(20):1727-1728. doi: 10.1182/blood.2020005449. Blood. 2020. PMID: 32407528 No abstract available.

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