在肺栓塞的抗凝血患者中大出血的出血风险得分的表现:来自CURES注册-2的见解
Yuzhi Tao1,2,3,4, Hong Chen5, Chunling Dong6
1Department of Pulmonary and Critical Care Medicine, The First Bethune Hospital of Jilin University, Jilin University, Changchun, China.
Thrombosis and haemostasis
|June 24, 2025
概括
瑞特得分适度预测肺栓塞 (PE) 患者的大型出血,有助于识别早期直接口服抗凝剂 (DOAC) 早期使用的低风险个体. 最初的DOACs减少了低风险PE患者的LMWH与LMWH相比的复合结果.
科学领域:
- 心脏病学 心脏病学
- 肺部医学 肺部医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 肺栓塞 (PE) 现有的出血风险评分主要是针对传统抗凝剂开发的.
- 关于这些评分在东亚人群和直接口服抗凝剂 (DOAC) 的适用性,存在有限的证据.
- 这项研究探讨了在现代抗凝固药疗法的背景下,对有效的风险评估工具的需求.
研究的目的:
- 评估PE患者大出血 (MB) 已确定的出血风险评分的预测性表现.
- 评估这些分数在识别适合DOAC治疗的患者中的有用性.
- 为了比较PE患者初始DOAC和低分子量肝素 (LMWH) 治疗之间的结果.
主要方法:
- 一项多中心前性研究 (NCT02943343) 的后期分析,涉及7,619名PE患者.
- 使用依赖时间的AUC,NRI和DCA评估出血风险得分,并对基线特征进行倾向得分匹配 (PSM).
- 分析90天内严重出血 (MB) 和综合结果 (所有原因死亡率,复发性静脉瘤,MB).
主要成果:
- 瑞特得分显示90天MB的预测能力适度 (AUC:0.70) 和显示在DCA.优势.
- 与其他得分相比,NRI表示RIETE得分的重新分类能力更好,但不包括HAS-BLED.
- 在RIETE评分确定的低风险患者中,初始DOAC治疗显著降低了14天复合结果与LMWH (HR=0.13) 相比.
结论:
- 在预测MB和确定PE患者低出血风险方面,RIETE得分表现不佳.
- 这一分数可能有助于在选择的PE患者中早期使用DOAC.
- 需要进一步的研究来证实其临床效用,特别是在东亚人群中.
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