Chest
Rules of Evidence and Clinical Recommendations on the Use of Antithrombotic Agents
Section snippets
LEVELS OF EVIDENCE
The participants in this undertaking, when summarizing what was known about the causes, clinical course, and management of a given entity, began by specifying the level of evidence that was being used in each case, according to the following classification:
SCIENTIFIC OVERVIEWS
Primary studies are often limited by inadequate sample size, which leaves negative studies open to large false-negative (ß) errors (in which important differences which actually exist may be missed). Moreover, even positive studies, when small, will generate such wide confidence intervals that clinicians are left uncertain whether the treatment effect is trivial or huge.
The starting point for an overview is asking the right question about a specific treatment for a specific disorder. Once this
THE GRADING OF RECOMMENDATIONS ABOUT THERAPY
The relation between Levels of Evidence and Grades of Recommendations regarding therapy is essentially unchanged from earlier reviews. Regardless of whether the Levels of Evidence were derived from overviews or individual trials, conference participants were encouraged to classify their ultimate recommendations on the use of antithrombotic therapy into 3 grades, depending on the level of evidence used to generate them:
Grade A Recommendation:
Supported by Level I Evidence
Grade B
EVALUATING THE IMPACT OF THERAPY: NUMBER NEEDED TO TREAT
Suppose that the results of a trial or overview are generalizable to your patient, and the outcomes are important; the next question is what is the impact of the intervention? A relative risk reduction may be quite impressive, but if the risk of an adverse outcome is low, the impact of treatment may be minimal. This notion of therapeutic impact can be captured in the concept called “the number needed to be treated” (NNT),14 which incorporates not only the relative risk reduction, but also the
REFERENCES (14)
- et al.
Effect of human chorionic gonadotropin on weight loss, hunger, and felling of well-being
Am J Clin Nutr
(1973) - et al.
Compliance with disulfiram treatment of alcoholism
J Chronic Dis
(1983) - et al.
Oral antibiotic prophylaxis in patients with cancer: a double-blind randomized placebo-controlled trial
J Pediatr
(1983) - et al.
Treatment adherence and risk of death after myocardial infarction
Lancet
(1990) - et al.
Agreement among reviewers of review articles
J Clin Epidemiol
(1991) - National Institutes of Health Consensus Development Conferences. 1977-1978;...
- Coronary Drug Project Reasearch Group. Influence of adherence treatment and response of cholesterol on mortality in the...
Cited by (388)
Vaccination in pediatric acquired inflammatory immune-mediated neuromuscular disorders
2022, European Journal of Paediatric Neurology“It is important to reinforce the importance of …”: ‘Hype’ in reports of randomized controlled trials
2019, English for Specific PurposesTotal Hip Arthroplasty Outcomes: An 18-Year Experience in a Single Center: Is Systemic Lupus Erythematosus a Potential Risk Factor for Adverse Outcomes?
2017, Journal of ArthroplastyCitation Excerpt :Briefly, all of them had recent urine and pharyngeal negative cultures and no other symptom or sign of active infection; no history of nonsteroidal anti-inflammatory drug or any antiplatelet drug intake in the 14-day period before the surgery; and an updated physiotherapy assessment. Besides, all included patients from both groups underwent the standard thromboprophylaxis protocol according to the current and available international practice guidelines and recommendations at the time of the surgery [19–24]. The primary outcome was the frequency of perioperative complications of THA in SLE patients, compared to the 2 different control groups (RA and OA).