使用机器学习和人口行政数据,在患有心房的患者中使用口服抗凝剂的最佳坚持值
Abdollah Safari1, Hamed Helisaz2, Mina Tadrous3
1School of Mathematics, Statistics, and Computer Science, College of Science, University of Tehran, Iran.
Journal of thrombosis and haemostasis : JTH
|November 12, 2025
概括
对于心房动 (AF) 中风预防的口服抗凝剂 (OAC) 的最佳坚持率高于传统的80%门. 更高的坚持,特别是直接OAC (DOAC),显著降低了临床事件风险.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 对于口服抗凝剂 (OAC) 在心房 (AF) 中风预防中的传统坚持定义是80%,缺乏临床验证.
- 确定临床相关的坚持值对于有效的AF管理至关重要.
- 这项研究调查了与减少的临床事件相关的最佳OAC坚持水平.
研究的目的:
- 确定与AF患者临床事件最大相关的OAC坚持值.
- 为了将这些最佳值与传统的80%坚持基准进行比较.
- 为了告知OAC遵守定义的潜在更新.
主要方法:
- 使用加拿大行政数据,对新的OAC使用者与AF (1996-2019) 的回顾性队列研究.
- 考克斯的比例危险模型分析了所覆盖日数 (PDC) 的比例作为主要暴露.
- 最小绝对收缩和选择操作员 (LASSO) 确定了最佳粘附值.
主要成果:
- 维生素K对抗剂 (VKA) 的最佳粘附值为PDC 0.85-0.95;对于直接OAC (DOAC),它是PDC 0.9.
- 与VKA相比,更高的坚持与DOAC (19%-52%) 与中风的风险降低有关.
- 传统的PDC 0.8值显示出较差的模型适合性和结果效应.
结论:
- 最佳的OAC坚持值高于传统的80%.
- 坚持值,特别是对DOACs,显著影响临床结果.
- 考虑将不合规性定义更新为PDC<0.9对于DOACs和<0.9或<0.95对于VKAs.
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