对静脉血栓栓塞复发和出血风险的动态预测模型的开发,以指导个性化抗凝治疗
Jonghyun Jeong1, Young-Mi Ah2, Ji Min Han3
1College of Pharmacy, Seoul National University, Seoul, Republic of Korea.
Journal of thrombosis and haemostasis : JTH
|February 15, 2026
概括
开发了预测模型,以评估静脉血栓栓塞 (VTE) 复发和口服抗凝剂治疗期间和之后严重出血的风险. 这些模型有助于个性化治疗决策,但在临床使用之前需要外部验证.
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.
- 医疗信息学 医疗信息学
背景情况:
- 口服抗凝剂对于治疗静脉血栓栓塞 (VTE) 是至关重要的.
- 对静脉血栓炎的抗凝固药治疗的最佳持续时间尚不清楚.
- 需要个性化风险评估来管理VTE.
研究的目的:
- 开发VTE复发和重大出血风险的预测模型.
- 在抗凝固剂治疗期间和之后,将时间变化的数据纳入动态风险评估.
- 支持VTE患者个性化治疗决策.
主要方法:
- 利用了14653名口服抗凝血剂的VTE患者的索赔数据库.
- 构建了在治疗和治疗之外的队列,以90天的间隔细分.
- 用于模型开发的雇佣最小绝对缩小和选择操作员回归.
- 通过引导,使用乐观度纠正的AUROC来评估模型性能.
主要成果:
- 发病率:在治疗期间2.7%的VTE复发,1.3%的大型出血,在停止治疗后0.8%的VTE复发.
- 乐观度调整后的AUROC为0.715 (模型1),0.828 (模型2) 和0.679 (模型3).
- 对模型2和模型3观察到低于最佳的校准.
结论:
- 开发的模型提供了动态VTE复发和出血风险评估的潜力.
- 模型可以为个性化抗凝药治疗持续时间的决定提供信息.
- 在临床实施之前,外部验证和重新校准至关重要.
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