风险评分在预测左心室辅助器件接受者的大出血中的表现:一个比较的外部验证
S F B van der Horst1, Y de Jong1,2, N van Rein2,3
1Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
Research and practice in thrombosis and haemostasis
|July 2, 2024
概括
目前的出血风险得分不足以预测左心室辅助器件 (LVAD) 接受者的严重出血. 需要一个新的,准确的风险评分来指导抗血栓治疗和改善患者的治疗结果.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 临床研究 临床研究
背景情况:
- 左心室辅助装置 (LVAD) 植入是末期心力衰竭的重要治疗方法.
- 大型出血 (MB) 是LVAD患者显著的植入后并发症.
研究的目的:
- 评估LVAD接收者大出血现有风险评分的预测准确性.
- 确定在这个患者群体中需要改进风险分层工具的需求.
主要方法:
- 在2010年11月至2022年12月期间,对104名LVAD接受者 (HeartWare/HeartMate-3) 进行了单中心观察性研究.
- 主要结果:使用ISTH,INTERMACS和INTERMACS+标准的第一个LVAD后MB.
- 评估多个已确定的出血风险得分,以进行歧视和校准.
主要成果:
- 高累积的MB发病率:75.7% (ISTH/INTERMACS+) 和67.0% (INTERMACS) 在1916天的中位随访期间.
- 所有评估的风险分数都显示出差的区分能力 (C统计 0.48-0.56).
- 模型显示校准不佳,持续低估了MB风险.
结论:
- 对于LVAD患者来说,现有的出血风险得分不足.
- 制定精确的风险评分对于识别高风险患者至关重要.
- 改进的风险评估可以个性化抗血栓治疗,提高患者的安全性.
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