通过延长抗凝剂平衡复发性静脉血栓栓塞和出血的风险:决策分析
Maria A de Winter1,2, Kednapa Thavorn3, Steven H J Hageman4
1Department of Acute Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Research and practice in thrombosis and haemostasis
|January 15, 2024
概括
在静脉血栓塞栓症 (VTE) 治疗后是否继续服用抗凝剂的决定涉及平衡复发和出血风险. 这项研究表明一个最佳的比率,但临床平衡仍然存在,突出了共享决策的重要性.
科学领域:
- 心血管医学 心血管医学
- 血液学 血液学 血液学
- 临床决策 - 临床决策
背景情况:
- 抗凝药是静脉血栓塞栓症 (VTE) 的标准.
- 在3个月后继续或停止抗凝药的决定需要平衡VTE复发风险与出血风险.
- 个性化风险评估对于最佳的患者管理至关重要.
研究的目的:
- 为了确定减少静脉瘤复发和增加出血风险之间的最佳平衡.
- 通过优化抗凝剂持续时间来最大限度地提高质量调整寿命年 (QALYs).
- 为了为患有VTE病史的患者提供临床决策信息.
主要方法:
- 一个微模拟模型被用来模拟5年的结果.
- 如果绝对复发风险降低超过出血风险的绝对增加,按特定比率加权,则分配扩展抗凝药.
- 来自出血风险研究和VTE-PREDICT得分的数据被用于估计风险.
主要成果:
- 确定了0.90的最佳比率,99%的模拟患者接受延长抗凝剂,产生额外的QALY.
- 这种最佳比率导致93个额外的QALY与最不有利的比率相比.
- 在最佳比例下以VTE-PREDICT为指导的治疗产生了44个额外的QALY与标准护理相比.
结论:
- 均衡出血风险和复发减少的最佳比率仍然不确定.
- 在VTE治疗后继续使用抗凝血剂方面存在临床平衡.
- 共同决策对于指导VTE患者的抗凝血管理至关重要.
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