Prognostic Factors for VTE and Bleeding in Hospitalized Medical Patients: A Systematic Review and Meta-Analysis

Many predictors for venous thromboembolism (VTE) and bleeding in hospitalized medical patients may exist but until now systematic reviews and assessments of the certainty of the evidence do not exist. We conducted a systematic review to identify prognostic factors for VTE and bleeding in hospitalized medical patients and searched Medline and EMBASE from inception to 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 (GRADE) approach. Of 69,410 citations, we included 17 studies; 14 that reported on VTE and identified 29 candidate prognostic factors and three that reported on bleeding and identified 17 candidate factors. For VTE, moderate certainty evidence shows a probable association with older age, elevated CRP, D-dimer, fibrinogen levels, heart rate, thrombocytosis, leukocytosis, fever, leg edema, lower Barthel Index score, immobility, paresis, previous history of VTE, thrombophilia, malignancy, critical illness and infections. For bleeding, moderate certainty evidence shows 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 central venous catheter (CVC). Elevated CRP, a lower Barthel Index, history of malignancy and elevated heart rate are not included in most VTE risk assessment models (RAMs). This study informs risk prediction in the management of hospitalized medical patients for VTE and bleeding, related research and guidelines for VTE prevention.