在正在考虑静脉血栓塞栓症预防的患者中预测出血
Shalini Sahoo1, Hilary Hayssen1, Brian Englum2
1Department of Surgery, University of Maryland, Baltimore, MD; Surgery Service, Veterans Affairs Medical Center, Baltimore, MD.
概括
静脉血栓塞栓症预防的风险评估模型对住院患者出血的预测能力较低. 目前的模型需要在广泛临床使用之前进行重大修改,以确保患者的安全.
科学领域:
- 内部医学 内部医学
- 药理学 药理学是指药理学的学科.
- 临床风险评估临床风险评估
背景情况:
- 静脉血栓栓塞 (VTE) 是可预防的医院死亡的主要原因之一.
- 对VTE的药物预防降低了发病率,但增加了出血风险.
- 准确的出血风险分层对于指导预防决策至关重要.
研究的目的:
- 评估IMPROVE和共识出血风险评估模型 (RAMs) 对医院出血的预测能力.
- 评估一大批未经选择的手术和非手术患者的RAM表现.
- 确定当前RAMs用于指导VTE预防的实用性.
主要方法:
- 在1298个退伍军人事务机构 (2016-2021) 中分析了1,228,448个独特的入院病例.
- 使用电子医疗记录数据计算IMPROVE和Consensus的RAM分数.
- 评估90天出血预测使用接收器运行特征曲线 (AUC) 下的面积.
主要成果:
- 5.6%的患者在90天内经历出血事件.
- 两种IMPROVE (AUC=0.61) 和共识 (AUC=0.59) 的RAM都显示出出血的预测能力较低.
- 低预测性表现在各种患者子组和时间点 (30,60,90天) 中一致.
结论:
- 现有的IMPROVE和共识出血RAMs在预测住院患者出血的能力有限.
- 这些模型需要实质性修改和重新评估,以便普遍适用.
- 需要改进的出血风险分层工具来优化静脉瘤预防策略.
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