Development of a standardized definition for clinically significant bleeding in the ASPirin in Reducing Events in the Elderly (ASPREE) trial
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 qual...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-09-01
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| Series: | Contemporary Clinical Trials Communications |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451865418300152 |
| _version_ | 1828425043819888640 |
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| author | Karen L. Margolis Suzanne E. Mahady Mark R. Nelson Diane G. Ives Suzanne Satterfield Carlene Britt Saifuddin Ekram Jessica Lockery Erin C. Schwartz Robyn L. Woods John J. McNeil Erica M. Wood |
| author_facet | Karen L. Margolis Suzanne E. Mahady Mark R. Nelson Diane G. Ives Suzanne Satterfield Carlene Britt Saifuddin Ekram Jessica Lockery Erin C. Schwartz Robyn L. Woods John J. McNeil Erica M. Wood |
| author_sort | Karen L. Margolis |
| collection | DOAJ |
| description | 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). Keywords: Aspirin, Primary prevention, Methods, Hemorrhage, Bleeding |
| first_indexed | 2024-12-10T16:26:55Z |
| format | Article |
| id | doaj.art-3cddc4d2299547b7a0db21362790e2a2 |
| institution | Directory Open Access Journal |
| issn | 2451-8654 |
| language | English |
| last_indexed | 2024-12-10T16:26:55Z |
| publishDate | 2018-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Contemporary Clinical Trials Communications |
| spelling | doaj.art-3cddc4d2299547b7a0db21362790e2a22022-12-22T01:41:39ZengElsevierContemporary Clinical Trials Communications2451-86542018-09-01113036Development of a standardized definition for clinically significant bleeding in the ASPirin in Reducing Events in the Elderly (ASPREE) trialKaren L. Margolis0Suzanne E. Mahady1Mark R. Nelson2Diane G. Ives3Suzanne Satterfield4Carlene Britt5Saifuddin Ekram6Jessica Lockery7Erin C. Schwartz8Robyn L. Woods9John J. McNeil10Erica M. Wood11HealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN, 55440-1524, USA; Corresponding author.School of Public Health & Preventive Medicine, Monash University, Melbourne, AustraliaMenzies Institute for Medical Research, University of Tasmania, Hobart, AustraliaDepartment of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USAUniversity of Tennessee Health Science Center, Memphis, TN, USASchool of Public Health & Preventive Medicine, Monash University, Melbourne, AustraliaSchool of Public Health & Preventive Medicine, Monash University, Melbourne, AustraliaSchool of Public Health & Preventive Medicine, Monash University, Melbourne, AustraliaHealthPartners Institute, Mailstop 23301A, PO Box 1524, Minneapolis, MN, 55440-1524, USASchool of Public Health & Preventive Medicine, Monash University, Melbourne, AustraliaSchool of Public Health & Preventive Medicine, Monash University, Melbourne, AustraliaSchool of Public Health & Preventive Medicine, Monash University, Melbourne, AustraliaBackground: 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). Keywords: Aspirin, Primary prevention, Methods, Hemorrhage, Bleedinghttp://www.sciencedirect.com/science/article/pii/S2451865418300152 |
| spellingShingle | Karen L. Margolis Suzanne E. Mahady Mark R. Nelson Diane G. Ives Suzanne Satterfield Carlene Britt Saifuddin Ekram Jessica Lockery Erin C. Schwartz Robyn L. Woods John J. McNeil Erica M. Wood Development of a standardized definition for clinically significant bleeding in the ASPirin in Reducing Events in the Elderly (ASPREE) trial Contemporary Clinical Trials Communications |
| title | Development of a standardized definition for clinically significant bleeding in the ASPirin in Reducing Events in the Elderly (ASPREE) trial |
| title_full | Development of a standardized definition for clinically significant bleeding in the ASPirin in Reducing Events in the Elderly (ASPREE) trial |
| title_fullStr | Development of a standardized definition for clinically significant bleeding in the ASPirin in Reducing Events in the Elderly (ASPREE) trial |
| title_full_unstemmed | Development of a standardized definition for clinically significant bleeding in the ASPirin in Reducing Events in the Elderly (ASPREE) trial |
| title_short | Development of a standardized definition for clinically significant bleeding in the ASPirin in Reducing Events in the Elderly (ASPREE) trial |
| title_sort | development of a standardized definition for clinically significant bleeding in the aspirin in reducing events in the elderly aspree trial |
| url | http://www.sciencedirect.com/science/article/pii/S2451865418300152 |
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