CHEST Guidelines-Effectiveness-of-Anticoagulation-in-Critically-Ill (1)

Effectiveness-of-Anticoagulation-in-Critically-Ill (1)

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This document features correspondence related to two studies published in the journal "Chest." In the first letter, authors Tine Sylvest Meyhoff and colleagues respond to comments by Vargas and others regarding their systematic review on fluid management in sepsis. They discuss the applicability of the fragility index—a measure of a study's robustness—in trials versus meta-analyses. The authors argue that trial sequential analysis is more appropriate for evaluating meta-analyses as it mitigates random errors and determines the necessary sample size for conclusive results. They caution against excluding trials deemed fragile as it undermines the comprehensive assessment purpose of meta-analyses.<br /><br />In the second letter, a response from Dr. Tenggao Chen and colleagues critiques a study by Pineton de Chambrun et al. on anticoagulation in critically ill patients with antiphospholipid syndrome. Chen et al. raise concerns about "immortal time bias," which can skew study results by attributing survival benefits incorrectly to treatment. They suggest methods to rectify this bias, such as time-varying covariates or propensity scores. The critique points out potential selection bias, as patients not receiving anticoagulation might have had contraindications like coagulopathy. <br /><br />Pineton de Chambrun and colleagues, in their reply, acknowledge the challenges of immortal time bias in their retrospective study of a rare disease across many centers over a two-decade span. They affirm the importance of anticoagulation, acknowledging the historical context and the difficulty in conducting prospective studies for such rare conditions. They emphasize that anticoagulation is a standard treatment for patients with antiphospholipid syndrome and note that their findings align with existing literature. <br /><br />These discussions highlight the complexities and methodological considerations in conducting and interpreting medical research, especially in critical care and rare diseases.

Keywords

fluid management

sepsis

fragility index

trial sequential analysis

meta-analyses

anticoagulation

immortal time bias

antiphospholipid syndrome

critical care

medical research