OSF Preprints · Jan 2025
Frailty Assessment and Venous Thromboembolism: A Scoping Review Protocol
By McFarland, M M, Tritschler et al.
Venous thromboembolism (VTE) predominantly affects older adults. One out of 1,000 persons develops VTE annually, but those over age 70 account for 60% of these events.1 Although incompletely characterized, the increase in VTE risk with age is believed to stem from aging-related changes in hemostasis, thrombosis, inflammation, and aging-related risk factors like comorbid conditions.2 Because of its disproportionate impact on older patients, VTE commonly coexists with frailty. Frailty is an aging-related clinical syndrome of diminished physiologic reserve and vulnerability to adverse health outcomes that affects nearly one in four older adults.3, 4 There is increasing recognition of the importance of frailty as a predictive variable. For example, frailty is associated with 3-fold risk of bleeding and 6-fold risk of death in patients taking direct oral anticoagulants (DOACs).5 Frailty may have a significant influence on VTE management and outcomes, including bleeding rates, mortality, acute treatment (such as thrombolysis), long-term management (such as extended anticoagulation), and clinical decision-making (such as anticoagulant choice or dose). Moreover, frailty assessment and targeted interventions have been shown to improve outcomes in analogous stressful scenarios like surgery or cancer treatment, which could also apply to VTE.6, 7 Many instruments are available for measuring frailty, nearly all of which predict adverse health outcomes.3 These range from clinical tools, such as brief patient-reported outcome measures, to administrative definitions derived from electronic health record data (a comprehensive list of tools is available at eFrailty.org). Despite growing awareness of frailty and its relevance to the VTE population, the definition of frailty remains inconsistent across studies in the field. The optimal method to measure frailty in the VTE population has not been established. This hinders efforts to incorporate frailty into research and clinical care of patients with VTE to improve outcomes. We will frame our research question to JBI's mnemonic, PCC, participants, concept and context.8 What instruments are available to measure frailty in venous thromboembolic disease? 2 Participants: Adult patients, 18 years or older with diagnosis of venous thromboembolism (VTE) by self-report, provider, or administrative algorithm. Concept: frailty assessment; instruments to measure frailty Context: Any clinical setting worldwide