Risk scores for major bleeding from direct oral anticoagulants: comparing predictive performance in patients with atrial fibrillation.
Risk scores for major bleeding from direct oral anticoagulants: comparing predictive performance in patients with atrial fibrillation.
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DOI：
10.1016/j.rpth.2023.102285
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发表时间：
2024-01
影响因子：
4.6
通讯作者：
Luzum, Jasmine A.
中科院分区：
文献类型：
--
作者：
Campos-Staffico, Alessandra M.;Jacoby, Juliet P.;Dorsch, Michael P.;Limdi, Nita A.;Barnes, Geoffrey D.;Luzum, Jasmine A.
尽管直接口服抗凝剂(DOAC)在预防房颤(AF)卒中方面比华法林更安全，但主要的出血问题仍然存在。大多数出血风险评分早于DOAC批准。本研究旨在将年龄、出血史和非出血相关住院史[ABH]评分(DOAC治疗患者的表现)与其他5个评分(房颤[房颤]、高血压、肾/肝功能异常、中风、出血史或倾向、不稳定的国际正常化比率、老年人[>；在预测房颤患者中与DOAC相关的大出血方面，[65岁]、药物/酒精合并[出血]、肝脏、肝脏或肾脏疾病、酗酒、恶性肿瘤、老年、血小板减少或功能降低、再出血、高血压、贫血、遗传因素、过度跌倒风险及中风[HEMORR2HAGES]、更知情的心房颤动[房颤]、充血性心力衰竭、高血压、年龄≥75[加倍]、糖尿病、中风[加倍]-血管疾病[CHA2DS2-VASC]。在这项对服用利伐沙班或阿匹沙班的2364例非瓣膜性房颤患者(中位年龄，68.3岁；32.1%女性)的回顾性研究中，分析了国际血栓和止血学会定义的大出血(发生率，4.1%；n=97)。连续风险得分的时间依赖的接受者操作特征(ROC)曲线的C统计量是主要的比较指标，但其他指标，如决策曲线，也进行了比较。在100天时，Orbit-AF和Atria的C-统计量最高(分别为0.62和0.61，其他分数的ROC曲线下面积为0.60)；一些显著差异有利于Orbit-AF。在1100天时，Orbit-AF和Atria的C-统计量仍然最高(分别为0.62和0.61，其他评分的ROC曲线下面积再次为0.60)，Orbit-AF的C-统计量显著高于除Atria外的所有其他风险评分(P<0.05)。在2100天时，所有的C-统计量都是0.60，没有显著差异。决策曲线显示，Orbit-AF和Atria在100天时净收益最大，Atria在1100天时净收益最大，2100天时任何分数都没有明显的净收益。在最初的1100天内，Orbit-AF和Atria提供了最好的出血风险预测。在DOAC治疗的2100天内，6项出血风险评分均未提供预测性益处。直接口服抗凝剂(DOAC)比华法林更安全，但对出血的担忧依然存在。评估6个评分在预测DOAC大出血方面的比较性能。更好地了解房颤[Orbit-AF]治疗和房颤的抗凝和风险因素[Atria]的结果登记显示，在DOAC治疗的最初1100天，C-统计量最高。更好地了解房颤[Orbit-AF]治疗和房颤的抗凝和风险因素的结果登记[Atria]在确定DOAC大出血方面优于其他4个风险评分。
Despite direct oral anticoagulants (DOACs) being safer than warfarin for stroke prevention in atrial fibrillation (AF), major bleeding concerns persist. Most bleeding risk scores predate DOAC approval. This study aimed to compare the Age, history of Bleeding, and non-bleeding related Hospitalisation [ABH] score’s performance—derived for DOAC-treated patients—with those of 5 other scores (Anticoagulation and Risk Factors in Atrial Fibrillation [ATRIA], Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly [>65 years], Drugs/alcohol concomitantly [HAS-BLED], Hepatic, Hepatic or Renal Disease, Ethanol Abuse, Malignancy, Older Age, Reduced Platelet Count or Function, Re-Bleeding, Hypertension, Anemia, Genetic Factors, Excessive Fall Risk and Stroke [HEMORR2HAGES], Outcomes Registry for Better Informed Treatment of Atrial Fibrillation [ORBIT-AF], and Congestive heart failure, Hypertension, Age ≥75 [doubled], Diabetes, Stroke [doubled]-Vascular disease, Age 65–74, Sex category [CHA2DS2-VASc]) in predicting DOAC-related major bleeding in patients with AF. In this retrospective study of 2364 patients with nonvalvular AF on rivaroxaban or apixaban (median age, 68.3 years; 32.1% women), International Society on Thrombosis and Haemostasis–defined major bleeding (incidence, 4.1%; n = 97) was analyzed. C-statistics from time-dependent receiver operating characteristic (ROC) curves for continuous risk scores were the primary comparison metric, but other metrics, such as decision curves, were also compared. At 100 days, C-statistics were highest for ORBIT-AF and ATRIA (0.62 and 0.61, respectively, with other scores having an area under the ROC curve of <0.60); some significant differences favored ORBIT-AF. At 1100 days, C-statistics remained highest for ORBIT-AF and ATRIA (0.62 and 0.61, respectively, with other scores having an area under the ROC curve of <0.60 again), and ORBIT-AF had significantly higher C-statistics than those for all other risk scores (P < .05), except for ATRIA. At 2100 days, all C-statistics were <0.60 with no significant differences. Decision curves showed the greatest net benefit for ORBIT-AF and ATRIA at 100 days and for ATRIA at 1100 days, with no discernible net benefit for any of the scores at 2100 days. ORBIT-AF and ATRIA provided the best bleeding risk prediction within the first 1100 days. None of the 6 bleeding risk scores provided predictive benefit over 2100 days of DOAC treatment. Direct oral anticoagulants (DOACs) are safer than warfarin, but concerns about bleeding persist. Comparative performance of 6 scores in predicting major bleeding from DOACs was assessed. Outcomes Registry for Better Informed Treatment of Atrial Fibrilation [ORBIT-AF] and Anticoagulation and Risk Factors in Atrial Fibrillation [ATRIA] showed the highest C-statistics in the initial 1100 days of DOAC treatment. Outcomes Registry for Better Informed Treatment of Atrial Fibrillation [ORBIT-AF] and Anticoagulation and Risk Factors in Atrial Fibrillation [ATRIA] outperformed 4 other risk scores in identifying major bleeding from DOACs.
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影响因子：
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作者：
Heestermans, Marco;Poenou, Geraldine;Hamzeh-Cognasse, Hind;Cognasse, Fabrice;Bertoletti, Laurent
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