Evidence map›Paper›PMID 40683552›Full record

ArticleJournal of thrombosis and haemostasis : JTH2026

Development and validation of risk models for hospital-acquired bleeding in medical inpatients: the Medical Inpatients Thrombosis and Hemostasis (MITH) study.

Neil A Zakai, Katherine Wilkinson, Andrew D Sparks, Ryan T Packer, Nicholas S Roetker, Allen B Repp, Mansour Gergi, Chris Holmes, Mary Cushman, Timothy B Plante and 14 more

Abstract readValidation StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of thrombosis and haemostasis : JTH, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors.

Neil A ZakaiDepartment of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; University of Vermont Medical Center, Burlington, Vermont, USA. Electronic address: Neil.Zakai@med.uvm.edu.
Katherine WilkinsonDepartment of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.
Andrew D SparksDepartment of Medical Biostatistics, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.
Ryan T PackerDepartment of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.
Nicholas S RoetkerChronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.
Allen B ReppDepartment of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; University of Vermont Medical Center, Burlington, Vermont, USA.
Mansour GergiDepartment of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; University of Vermont Medical Center, Burlington, Vermont, USA.
Chris HolmesDepartment of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; University of Vermont Medical Center, Burlington, Vermont, USA.
Mary CushmanDepartment of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; University of Vermont Medical Center, Burlington, Vermont, USA.
Timothy B PlanteDepartment of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; University of Vermont Medical Center, Burlington, Vermont, USA.
Hanny Al-SamkariDepartment of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Allyson M PishkoDepartment of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
William A WoodDepartment of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Camila MasiasBaptist Health South Florida, Miami, Florida, USA.
Radhika GangarajuInstitute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Ang LiSection of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA.
David GarciaDivision of Hematology, University of Washington School of Medicine, Seattle, Washington, USA.
Kerri L WigginsDepartment of Medicine, University of Washington, Seattle, Washington, USA.
Jordan K SchaeferDivision of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan USA.
Nicholas L SmithDepartment of Epidemiology, University of Washington, Seattle, Washington, USA; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle Washington, USA; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA.
Augusto FerrarisDepartment of Epidemiology, University of Washington, Seattle, Washington, USA.
Karlyn A MartinDepartment of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; University of Vermont Medical Center, Burlington, Vermont, USA.
Deirdra R TerrellHudson College of Public Health, the University of Oklahoma Health Sciences, Oklahoma City, Oklahoma, USA.
Leslie A McClureDepartment of Epidemiology & Biostatistics, Saint Louis University College for Public Health & Social Justice, St. Louis, Missouri, USA.

Funding

AIM-AHEAD Coordinating Center - All Four CoresOT2OD032581 · OD · UNIVERSITY OF NORTH TEXAS HLTH SCI CTR · PI Paul Avillach, Bettina M. Beech · 2021 to 2026
$168.7M
Thrombosis and Bleeding Risk Assessment in Medical InpatientsR01HL141290 · NHLBI · UNIVERSITY OF VERMONT & ST AGRIC COLLEGE · PI Deirdra R Terrell, Neil Adrian Zakai · 2019 to 2026
$3.5M
Epidemiology and Biomarkers in Transplant Associated Thrombotic Microangiopathy (TA-TMA): A Prospective Validation Cohort StudyK23HL159271 · NHLBI · BAYLOR COLLEGE OF MEDICINE · PI Ang Li · 2022 to 2026
$835k
Implementing Prevention of Venous Thromboembolism for Ambulatory Patients with Cancer (PREVenT-APC)K23HL157758 · NHLBI · UNIVERSITY OF VERMONT & ST AGRIC COLLEGE · PI Karlyn Martin · 2022 to 2026
$831k
An Intervention to Reduce Cancer Associated Thrombosis Through Improved ProphylaxisK01HL169920 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Jordan Schaefer · 2023 to 2026
$684k
NHLBI NIH HHS K01 HL169920NHLBI NIH HHS K23 HL157758NHLBI NIH HHS K23 HL159271NHLBI NIH HHS R01 HL141290NIH HHS OT2 OD032581
6 · The paper itself

Abstract

backgroundHospital-acquired (HA) bleeding in medical inpatients is a serious complication with limited tools to predict risk.

objectivesThis study aimed to develop and validate risk assessment models (RAMs) for anatomic location-specific HA bleeding in medical inpatients using objective and routinely available risk factors.

methodsPatients aged ≥18 years admitted to medical hospital services from 6 health systems and 15 hospitals in the United States between 2016 and 2020 for at least 1 midnight and without bleeding at admission were eligible for inclusion. Two health systems (10 hospitals) formed the development cohort, and 4 systems (5 hospitals) constituted the validation cohort. Bayesian Least absolute shrinkage and selection operator was used to develop anatomic site-specific RAMs.

resultsAmong the development (153 707 admissions) and validation (137 460 admissions) cohorts, 5999 (3.9%) and 3282 (2.4%) HA bleeds occurred. RAMs had varied risk factors by anatomic bleeding location; for instance, older age was associated with genitourinary bleeding in men but not in women. Different cancer types were associated with different anatomic bleeding locations such as genitourinary cancers associated with genitourinary bleeding and gynecologic bleeding. The RAMs demonstrated good predictive performance for most anatomical bleeding locations; the C-statistic was ≥0.67 for all anatomic location bleeding in the development and validation cohorts and generally higher in the anatomic location specific RAMs.

conclusionThese RAMs provide anatomic location-specific and sex-specific HA-bleeding risk stratification, addressing a critical gap in individualized risk assessment. Integration into clinical workflows could enhance patient safety and outcomes. Implementation studies are essential to maximize their clinical utility.

Indexed as

HemorrhageHemostasisAdultAgedAged, 80 and overBayes TheoremFemaleHumansIatrogenic DiseaseInpatientsMaleMiddle AgedReproducibility of ResultsRisk AssessmentRisk FactorsUnited Stateshemorrhagehospitalizationinpatientsrisk assessmentrisk factors

Identifiers

PMID40683552
PMCPMC12329860

What Socratic holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.