在抗凝剂治疗中,研究对出血风险评估模型的研究进展
Li Sen1, Xiong Kangpin1,2, Liu Yihui1
1Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Frontiers in cardiovascular medicine
|November 27, 2025
概括
在抗凝剂治疗中,平衡出血风险和凝块预防是关键. 新的模型和生物标志物改善了对心房和静脉血栓塞瘤患者的风险评估,指导了更安全的抗凝策略.
科学领域:
- 心血管医学 心血管医学
- 药理学 药理学是指药理学的学科.
- 临床风险分层的临床风险分层
背景情况:
- 已建立的出血风险评估模型 (RAMs),如HAS-BLED,是为华法林设计的,不确定是否适用于非维生素K对抗剂口服抗凝剂 (NOACs) 和静脉血栓栓塞栓症 (VTE).
- 精确的出血风险分层对于优化抗凝剂治疗至关重要,平衡血栓栓塞预防与出血并发症.
研究的目的:
- 审查最近在心房动 (AF) 和接受抗凝药治疗的VTE患者出血风险分层方面的进展.
- 评估传统和新型RAM的性能,包括药物特定的适应和基于生物标志物的方法.
主要方法:
- 对近期关于AF和VTE群体出血风险评估模型的文献进行系统审查.
- 对模型性能指标 (例如,AUC,C-统计) 和不同抗凝剂疗法的临床适用性进行分析.
- 检查基于生物标志物的新兴工具和动态风险修饰剂.
主要成果:
- 传统的RAM在NOAC用户中显示了适度的预测准确性 (AUC:0.55-0.74),一些模型如HEMORR和HAGES表现更好.
- 生物标志物集成模型 (例如ABC,DOAC分数) 和适应环境的VTE模型 (例如IMPROVE,RIETE) 表明风险分层有所改善.
- 研究设计和终点定义的异质性限制了当前模型的概括性,突出了对精细方法的需求.
结论:
- 目前的RAM具有可变的性能,需要下一代模型整合动态因素和生物标志物来实现精确的抗凝.
- 特定于NOAC的工具更适合于AF患者,而适应环境的模型更适合于VTE人群.
- 未来的研究必须专注于现实世界的验证,机器学习和标准化的出血定义,以提高抗凝血的安全性和有效性.
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