Thrombosis and Haemostasis
Author Interview
Stroke, Systemic or Venous Thromboembolism
Stephan Nopp, Clemens P. Spielvogel, Sabine Schmaldienst, Renate Klauser-Braun, Matthias Lorenz, Benedikt N. Bauer, Ingrid Pabinger, Marcus Säemann, Oliver Königsbrügge, Cihan Ay
Thromb Haemost
DOI: 10.1055/a-1754-7551
T&H
Why did you (and your colleagues) write this paper? What was its main purpose?
STEPHAN NOPP
When initiating the VIVALDI study in 2014, we wanted to better understand the risk of thromboembolism and bleeding in patients with end-stage kidney disease on hemodialysis. The bleeding rate in these patients has been reported to be high, around 9 per 100 patient-years. However, no valid approach to assess the individual risk of bleeding in this high risk population has been established. Therefore, the main purpose of the work presented in this paper was to improve bleeding risk prediction in this special patient population.
T&H
What are the main conclusions?
STEPHAN NOPP
Taken together, both currently existing bleeding risk scores, which have been predominantly developed and used in a broader population of patients, and our machine learning-based approach, which incorporated patient demographics, clinical characteristics, and laboratory measurements, failed to predict major bleeding in patients with end-stage kidney disease on hemodialysis.
T&H
What are the paper's implications? - to the public? -to medical professionals?
STEPHAN NOPP
Patients on hemodialysis are at high risk for bleeding and bleeding risk assessment could guide clinical decision-making with regard to anticoagulation strategies or dialysis treatment modalities. However, no current approach to bleeding risk prediction in hemodialysis patients is reliable and more research effort is needed to better characterize the risk of bleeding in these patients.
T&H
Are the findings clinically significant? Should the findings change practice?
STEPHAN NOPP
Patients on hemodialysis represent a unique patient population in which current bleeding risk scores and standard clinical parameters fail to predict the risk of bleeding, unlike in the general non-dialysis population. Importantly, no current approach to bleeding risk prediction in patients on hemodialysis can be recommended to date, and physicians need to generally take the very high bleeding risk in this patient population into account. More work needs to be done to identify risk factors for bleeding in this special patient population at high baseline risk for bleeding to advance the field.
