Development of a standardized definition for clinically significant bleeding in the ASPirin in Reducing Events in the Elderly (ASPREE) trial.

Autor:	Margolis KL; HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN, 55440-1524, USA., Mahady SE; School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia., Nelson MR; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia., Ives DG; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA., Satterfield S; University of Tennessee Health Science Center, Memphis, TN, USA., Britt C; School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia., Ekram S; School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia., Lockery J; School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia., Schwartz EC; HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN, 55440-1524, USA., Woods RL; School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia., McNeil JJ; School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia., Wood EM; School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.
Jazyk:	angličtina
Zdroj:	Contemporary clinical trials communications [Contemp Clin Trials Commun] 2018 May 22; Vol. 11, pp. 30-36. Date of Electronic Publication: 2018 May 22 (Print Publication: 2018).
DOI:	10.1016/j.conctc.2018.05.015
Abstrakt:	Background: Bleeding is the major risk of aspirin treatment, especially in the elderly. A consensus definition for clinically significant bleeding (CSB) in aspirin primary prevention trials is lacking in the literature. Methods: This paper details the development, modification, application, and quality control of a definition for clinically significant bleeding in the ASPirin in Reducing Events in the Elderly (ASPREE) trial, a primary prevention trial of aspirin in 19,114 community-dwelling elderly men and women. In ASPREE a confirmed bleeding event needed to meet criteria both for substantiated bleeding and clinical significance. Substantiated bleeding was defined as: 1) observed bleeding, 2) a reasonable report of symptoms of bleeding, 3) medical, nursing or paramedical report, or 4) imaging evidence. Bleeding was defined as clinically significant if it: 1) required transfusion of red blood cells, 2) required admission to the hospital for >24 h, or prolonged a hospitalization, with bleeding as the principal reason, 3) required surgery to stop the bleeding, or 4) resulted in death. Bleeding sites were subclassified as upper gastrointestinal, lower gastrointestinal, intracranial (hemorrhagic stroke, subarachnoid hemorrhage, subdural hematoma, extradural hematoma, or other), or other sites. Potential events were retrieved from medical records, self-report or notification from treating doctors. Two reviewers adjudicated each event using electronic adjudication software, and discordant cases were reviewed by a third reviewer. Adjudication rules evolved to become more strictly defined as the trial progressed and decision rules were added to assist with frequent scenarios such as post-operative bleeding. Conclusions: This paper provides a detailed methodologic description of the development of a standardized definition for clinically significant bleeding and provides a benchmark for development of a consensus definition for future aspirin primary prevention trials. Trial Registration: ASPREE is registered on the International Standard Randomized Controlled Trial Number Register (ISRCTN83772183) and on clinicaltrials.gov (NCT01038583).
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu