Management of Persons With Haemophilia Requiring Antithrombotic Therapy: A Canadian Modified Delphi Consensus Study
Bibliographic record
Abstract
INTRODUCTION: Advancements in haemophilia care have extended the life expectancy of persons with haemophilia (PWH), giving rise to new clinical challenges including the need for antithrombotic therapy (ATT) in mitigating arterial or venous thrombotic risk. However, evidence to support clinical decision-making in this context remains limited, despite its growing importance. AIMS: To develop Canadian consensus recommendations for managing PWH requiring ATT. METHODS: A modified Delphi technique was used. Initial statements were generated using information from a scoping literature review and focus groups with Canadian haemophilia experts. Key areas included risk assessment, tailored treatment planning, ATT selection and management of breakthrough bleeding. Expert panellists were recruited through the Association of Haemophilia Clinic Directors of Canada using convenience sampling. Participants independently reviewed and rated each statement using a 7-point agreement-based Likert scale, with consensus defined a priori as over 70% agreement among panellists. Statements that did not reach consensus in the first round were modified based on participants' comments. RESULTS: Eight physicians (median experience in PWH care: 11.0 years) from five haemophilia treatment centres across four Canadian provinces participated. All panellists had experience managing thromboembolic complications and using ATTs in PWH. Consensus was attained for 32 statements on general aspects of care, risk assessment, treatment planning and management of bleeding complications. All statements attained consensus after two rounds with a 100% completion rate. CONCLUSION: This Canadian study yielded 32 consensus-based recommendations for managing PWH requiring ATT, addressing an unmet need to guide clinical decision-making in this complex and evolving area.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.058 | 0.065 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.007 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".