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Rev Clin Esp. 2018 Oct;218(7):358-371. doi: 10.1016/j.rce.2018.04.006. Epub 2018 May 22.

Delphi-RAND consensus of the Spanish Society of Internal Medicine on the controversies in anticoagulant therapy and prophylaxis in medical diseases. INTROMBIN Project (Uncertainty in thromboprophylaxis in internal medicine).

[Article in English, Spanish]

Author information

1
Servicio de Medicina Interna, Hospital San Juan de Dios del Aljarafe, Bormujos (Sevilla), España.
2
Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla y Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Sevilla, España; Departamento de Medicina, Universidad de Sevilla, Sevilla, España. Electronic address: medrano@cica.es.
3
Servicio de Medicina Interna, Hospital Universitario Virgen de Valme, Sevilla, España.
4
Departamento de Medicina, Universidad de Sevilla, Sevilla, España; Servicio de Medicina Interna, Hospital Universitario Virgen de Valme, Sevilla, España.
5
Distrito Sanitario de Atención Primaria Sevilla. CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, España.
6
Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla y Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Sevilla, España.
7
Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España; Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla y Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Sevilla, España; Departamento de Medicina, Universidad de Sevilla, Sevilla, España.

Abstract

The aim of this study was to determine the opinion of internists on the management of anticoagulation and thromboembolism prophylaxis in complex clinical scenarios in which the risk-benefit ratio of surgery is narrow and to develop a consensus document on the use of drugs anticoagulant therapy in this patient group. To this end, we identified by consensus the clinical areas of greatest uncertainty, a survey was created with 20 scenarios laid out in 40 clinical questions, and we reviewed the specific literature. The survey was distributed among the internists of the Spanish Society of Internal Medicine (SEMI) and was completed by 290 of its members. The consensus process was implemented by changing the Delphi-RAND appropriateness method in an anonymous, double-round process that enabled an expert panel to identify the areas of agreement and uncertainty. In our case, we also added the survey results to the panel, a methodological innovation that helps provide additional information on the standard clinical practice. The result of the process is a set of 19 recommendations formulated by SEMI experts, which helps establish guidelines for action on anticoagulant therapy in complex scenarios (high risk or active haemorrhage, short life expectancy, coexistence of antiplatelet therapy or comorbidities such as kidney disease and liver disease), which are not uncommon in standard clinical practice.

KEYWORDS:

Anticoagulant therapy; Anticoagulantes; Consenso; Consensus; Enfermedad tromboembólica venosa; Profilaxis; Prophylaxis; Riesgo; Risk; Venous thromboembolism disease

PMID:
29793759
DOI:
10.1016/j.rce.2018.04.006

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