Bristol Trials Centre (Clinical Trials and Evaluation Unit), Bristol Medical School, University of Bristol, Bristol, UK; NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK.
Bristol Heart Institute, Bristol, UK.
J Clin Epidemiol. 2022 Aug;148:115-123. doi: 10.1016/j.jclinepi.2022.03.018. Epub 2022 Mar 26.
To identify potential confounders and co-interventions systematically to optimise control of confounding for three non-randomized studies of interventions (NRSI) designed to quantify bleeding in populations exposed to different dual antiplatelet therapy (DAPT).
Systematic review, interviews, and surveys with clinicians. We searched Ovid Medline, Ovid Embase, and the Cochrane Library to identify randomized-controlled trials and cohort studies of DAPT interventions. Two researchers independently screened citations, identified eligible studies and extracted data. We conducted individual semi-structured interviews with six cardiologists and six cardiac surgeons to elicit factors clinicians consider when they prescribe DAPT. We administered two online surveys for members of professional cardiology and cardiac surgery organisations.
We screened 2,544 records, identified 322 eligible studies, and extracted data from 47. We identified 10 co-interventions and 70 potential confounders: review 31 (91%); interviews 19 (56%); surveys 31 (91%). 16/34 (47%) were identified by all three methods while, 3/34 (9%) were picked up by one method only.
The review identified the majority of factors, but the interviews identified hard-to-measure factors such as perceived patient adherence and local prescribing culture. The methods could, in principle, be widely applied when designing or reviewing non-randomized studies of interventions (NRSI).
系统识别潜在混杂因素和共同干预因素，以优化三种旨在量化不同双联抗血小板治疗（DAPT）暴露人群出血的干预措施（NRSI）的混杂控制。
系统评价、与临床医生的访谈和调查。我们在 Ovid Medline、Ovid Embase 和 Cochrane 图书馆中搜索了 DAPT 干预措施的随机对照试验和队列研究。两名研究人员独立筛选引文，确定合格的研究并提取数据。我们对六名心脏病专家和六名心脏外科医生进行了单独的半结构化访谈，以了解临床医生在开 DAPT 时考虑的因素。我们为心脏病学和心脏外科学会的成员进行了两次在线调查。
我们筛选了 2544 篇记录，确定了 322 项合格的研究，并从 47 项研究中提取了数据。我们确定了 10 种共同干预措施和 70 种潜在混杂因素：综述 31 项（91%）；访谈 19 项（56%）；调查 31 项（91%）。通过所有三种方法确定了 16/34（47%）个因素，而只有一种方法确定了 3/34（9%）个因素。
综述确定了大多数因素，但访谈确定了难以测量的因素，如感知到的患者依从性和当地的处方文化。在设计或审查干预措施的非随机研究（NRSI）时，这些方法原则上可以广泛应用。
