随着时间的推移,NOACS与VKAS对绝对和相对认知功能下降的影响:机器学习方法
Sergio Ferrantelli1,2, Mario Daidone1,2, Giuseppe Armentaro3
1Internal Medicine and Stroke Care Ward, University of Palermo, Palermo, Italy.
Thrombosis and haemostasis
|September 10, 2025
概括
非维生素K对抗剂口服抗凝剂 (NOACs) 与维生素K对抗剂 (VKAs) 相比,可能有助于在患有心房 (AF) 的老年患者中保持认知功能. 这项研究表明,NOAC与AF患者认知能力下降的风险较低有关.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 老年病的医生 老年病的医生
背景情况:
- 心房动 (AF) 是老年人常见的心律失常,即使没有先前的中风,也会增加痴呆症的风险.
- 非维生素K对抗剂口服抗凝剂 (NOACs) 与维生素K对抗剂 (VKAs) 相比,具有安全优势,但它们对认知的影响尚不清楚.
研究的目的:
- 评估NOAC与VKA对老年AF患者认知能力下降的影响.
- 利用机器学习方法来预测基于抗凝剂类型的认知衰退.
主要方法:
- 一项针对983名AF门诊患者 (2008-2022) 的前性队列研究,使用迷你心理状态检查 (MMSE) 进行认知评估.
- 多变量后勤回归和随机森林分类器用于分析抗凝剂类型对认知衰退的预测能力.
- 通过类加权学习和SMOTE解决类不平衡;通过交叉验证和值优化验证模型性能.
主要成果:
- 接受VKA治疗的患者在平均7.2年的随访期间,MMSE得分下降幅度明显更大 (-1.7分) 与NOAC治疗的患者相比 (-0.3分).
- NOAC的使用独立地与较低的认知能力下降风险有关 (OR:0.322,p < 0.0001).
- 随机森林模型实现了高预测准确性 (AUC 0.8719),NOAC用户显示认知衰退的预测概率较低 (VKA用户的中位数为0.09与0.70).
结论:
- 使用NOAC与老年AF患者认知能力下降的风险降低和预测概率降低有关.
- 研究结果表明,NOAC在这个人群中比VKA更有潜在的认知益处.
- 机器学习模型有效地确定了抗凝剂类型作为认知衰退的关键预测因素.
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