CHEST Guidelines-Effectiveness-of-Anticoagulation-in-Critically-Ill

Effectiveness-of-Anticoagulation-in-Critically-Ill

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This document contains correspondences related to two separate medical studies published in the journal "CHEST." The first correspondence, a response to comments by Vargas and colleagues, discusses the application of the Fragility Index in the context of a systematic review comparing lower versus higher fluid volumes in the initial management of sepsis. While agreeing with the utility of the Fragility Index in assessing the robustness of trial results, the authors argue that trial sequential analysis (TSA) is more appropriate for systematic reviews and meta-analyses. TSA helps assess the risk of random errors and determine the necessary sample size to reach definitive conclusions.<br /><br />The second correspondence addresses potential biases in a study on the effectiveness of anticoagulation in critically ill patients with Antiphospholipid Syndrome (APS). Chen and colleagues point out potential immortal time bias in the study, which refers to periods where patients could not have experienced the outcome of interest due to the study's design. They suggest methodologies to correct for such biases. In response, the authors of the APS study argue that despite potential biases due to its retrospective nature and limited sample size, their findings align with established treatments for APS and catastrophic APS. They acknowledge inherent bias but emphasize that the study indicates anticoagulation is crucial, as failure to administer it can lead to poorer outcomes.<br /><br />Overall, the document highlights ongoing discourse in medical research striving to refine methodologies to ensure more robust and reliable results in critical care settings.

Keywords

Fragility Index

trial sequential analysis

systematic review

meta-analysis

sepsis management

anticoagulation

Antiphospholipid Syndrome

immortal time bias

retrospective study

critical care research