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

作者：Andrea J. Darzi, Samer G. Karam, Rana Charide, Itziar Etxeandia‐Ikobaltzeta, Mary Cushman, Michael K. Gould, Lawrence C. E. Mbuagbaw, Frederick Alan Spencer, Alex C. Spyropoulos, Michael Blake Streiff, Scott C. Woller, Neil A. Zakai, Federico Germini, Marta Rigoni, Arnav Agarwal, Rami Z. Morsi, Alfonso Iorio, Elie A. Akl, Holger Jens Schünemann · 发表于：Blood · 年份：2020 · DOI：10.1182/blood.2019003603 · 被引用次数：135 · 研究领域：Venous Thromboembolism Diagnosis and Management、Central Venous Catheters and Hemodialysis、Diagnosis and Treatment of Venous Diseases

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 cath...