基于模型指导的静脉血栓栓塞的估计影响 预防与医生实践对比
Benjamin G Mittman1,2,3, Michael B Rothberg2,3
1Medical Scientist Training Program, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
medRxiv : the preprint server for health sciences
|June 10, 2025
概括
在医疗住院患者的静脉血栓塞栓症 (VTE) 的模型导向预防可以提高效率. 与医生的判断相比,一个特定的基于模型的策略减少了预防的使用和总事件,强调了决策支持的需要.
科学领域:
- 内部医学 内部医学
- 血液学 血液学 血液学
- 临床决策 - 临床决策
背景情况:
- 美国血液学会 (ASH) 准则建议对静脉血栓栓塞 (VTE) 和大出血进行风险评估,以优化医疗住院患者的药理性VTE预防.
- 在这种人群中使用风险模型指导VTE预防的临床实用性在很大程度上仍未确定.
研究的目的:
- 以风险预测模型为指导的风险预测模型与标准医生的判断来比较静脉瘤,严重出血和预防效率.
- 在不同预防策略中量化VTE或出血事件需要治疗的数量 (NNT).
主要方法:
- 分析了2017年12月至2020年1月期间入院于克利夫兰诊所10家医院的成年患者.
- 使用ASH推的 (Padua,IMPROVE) 和克利夫兰诊所衍生风险模型,医生处方的预防与假设的预防策略进行了比较.
- 对每个策略计算了预防率,VTE率,主要出血率和增量NNT.
主要成果:
- 医生的判断导致了62%的患者进行预防;基于模型的策略建议17-87%的患者进行预防.
- 模型导向的预防导致更多的静脉动脉事件和较少的重大出血比医生的判断,每1000名患者的总事件从模型的14.0-16.1到医生的14.3不等.
- 最有效的基于模型的策略,建议28%的患者进行预防,与医生相比,减少了55%的预防使用和0.14%的总事件,NNT为80.
结论:
- 医生处方模式经常包括不适当的VTE预防,强调需要临床决策支持工具.
- 基于模型的预防策略通过减少接受预防的患者数量和与医生的判断相比,静脉动脉突发症和出血事件的总数,显示出更高的效率.
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