Introduction: Recent studies have reported the development of venous blood flow stasis in astronauts and an occlusive venous thrombosis during spaceflight. Subsequent investigations revealed approximately one quarter of surveilled crew members had some degree of blood flow stasis in the left internal jugular vein. Therefore, NASA’s Human System Risk Board now formally tracks venous thromboembolism (VTE) as a “concern” for human spaceflight. To investigate potential mechanisms by which exposures concomitant with spaceflight (e.g., microgravity, radiation) may contribute to VTE, we developed a causal diagram in the form of a directed acyclic graph (DAG). Methods: The mechanisms by which spaceflight exposures may elevate the risk of VTE and the downstream effects on mission outcomes were critically analyzed, taking into account scientific literature and subject matter expertise consultation, and a DAG was generated. A Level-of-Evidence score for each causal relationship was assigned based on assessing the literature against a set of criteria derived from the A. Bradford Hill Causal Guidelines. Results: The set of three main factors that predispose people to VTE (hypercoagulability, endothelial damage, and blood stasis) is known as Virchow’s Triad. In constructing the DAG for VTE we articulated various mechanisms by which the principal spaceflight hazards (microgravity, radiation, closed hostile environment, isolation and confinement, distance from Earth) are thought to interact with or cause the components in Virchow’s triad. We found sufficient evidence to at least speculate that fluid shifts from microgravity, compensatory alterations in hematologic indices, spaceflight atmospheric conditions, and oxidative stress/inflammation from radiation may be potential contributors to VTE development. Discussion: Developing the DAG entailed a systematic and repeatable approach for visualizing relationships between contributing factors that may lead to VTE in spaceflight. Articulating pathways linking spaceflight exposures to VTE risk factors and possible VTE development enables subject matter experts from different domains to construct a shared mental model. Assignment of levels of evidence scores to the relationships helps identify knowledge and capability gaps that should be considered for further investigation. Furthermore, the DAG highlights modifiable variables and may therefore facilitate the development of new VTE risk mitigation strategies.
Development of A Directed Acyclic Graph for Venous Thromboembolism During Spaceflight
2023 Aerospace Medical Conference ; 2023 ; New Orleans, LA , US
Conference paper
No indication
English
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