预测不同时间范围内静脉血栓栓塞抗凝过程中的颅内出血：Riete Registry的发现
Predicting intracranial bleeding during anticoagulation for venous thromboembolism within different time frames: Findings from the RIETE registry
影响因子:3.40000
分区:医学3区 / 血液学2区 外周血管病3区
发表日期:2024 Nov
作者:
Ana Maestre, Mar Martín Del Pozo, Farès Moustafa, Romain Chopard, José Antonio Nieto, María Ángeles Fidalgo Fernández, Patricia López Miguel, Peter Verhamme, Maurizio M Ciammaichella, Manuel Monreal,
摘要
抗凝静脉血栓栓塞（VTE）期间颅内出血的风险是实质性的，并且持续了最初的治疗阶段。我们的目的是通过特定阶段的预后分数来完善风险评估。我们从2009年3月至2023年10月确定了Riete注册中7786名VTE患者的数据，以开发两个颅内出血的预后得分。多变量COX的回归用于分析早期（≤90天）和晚期（> 90天）阶段的不同变量，并具有针对现有得分的比较验证（修改了ACCP，RIETE，VTE，VTE-BLEED和CHAP）。在411名患者（0.53％）中，在208阶段中发生了颅骨出血。 30天的死亡率分别为45％和35％。这两个阶段的共同预测因素包括基线异常的精神状态，脑癌，近期颅内出血和癫痫。早期出血独有的是体重，非脑癌，高血压，痴呆，血小板减少症，肾脏功能不全和溶栓疗法。高龄，肺栓塞最初，先前中风，抑郁症，直接口服抗凝剂的治疗以及使用皮质类固醇的使用预测后期出血。两种预后分数均表现为0.68，表现优于现有得分。该研究介绍了VTE抗凝过程中颅内出血的两个时间预后评分。通过辨别与每个治疗阶段有关的特定风险因素，这些得分表现优于传统模型，提供了用于临床决策的先进工具。它们具有优化抗凝管理和降低与出血相关的死亡率的巨大潜力。
Abstract
The risk of intracranial bleeding during anticoagulation for venous thromboembolism (VTE) is substantial and persists beyond the initial treatment phase. We aimed to refine risk-assessment through phase-specific prognostic scores.We identified data from 77,786 VTE patients in the RIETE registry from March 2009 to October 2023 to develop two prognostic scores for intracranial bleeding. Multivariable Cox regression was used to analyze distinct variables for the early (≤90 days) and late (>90 days) phases, with comparative validation against existing scores (modified ACCP, RIETE, VTE-BLEED, and CHAP).Intracranial bleeding occurred in 411 patients (0.53 %), with 208 cases in the early phase and 203 in the late phase. The 30-day mortality was 45 % and 35 %, respectively. Shared significant predictors for both phases include baseline abnormal mental status, brain cancer, recent intracranial bleeding, and epilepsy. Unique to early-phase bleeding were body weight, non-brain cancer, hypertension, dementia, thrombocytopenia, renal insufficiency, and thrombolytic therapy. Advanced age, pulmonary embolism initially, prior stroke, depression, treatment with direct oral anticoagulants, and use of corticosteroids predicted late-phase bleeding. Both prognostic scores showed a c-statistic of 0.68, outperforming existing scores.The study introduces two temporal prognostic scores for intracranial bleeding during anticoagulation for VTE. By discerning specific risk factors pertinent to each treatment phase, these scores outperform traditional models, offering an advanced tool for clinical decision-making. They hold significant potential for optimizing anticoagulation management and reducing bleeding-related mortality.