Doctor, what is my risk of bleeding after cardiac surgery while on combined anticoagulant with antiplatelet therapy? A validated nomogram for risk assessment
BackgroundPatients with comorbid coronary artery disease and valvular heart disease usually undergo coronary artery bypass grafting alongside valve replacement or ring repair surgeries. Following these procedures, they typically receive a combination of anticoagulation and antiplatelet therapy, whic...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2024.1528390/full |
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| author | Haolong Han Haolong Han Hang Xu Hang Xu Jifan Zhang Weihui Zhang Yi Yang Xia Wang Li Wang Dongjin Wang Weihong Ge |
| author_facet | Haolong Han Haolong Han Hang Xu Hang Xu Jifan Zhang Weihui Zhang Yi Yang Xia Wang Li Wang Dongjin Wang Weihong Ge |
| author_sort | Haolong Han |
| collection | DOAJ |
| description | BackgroundPatients with comorbid coronary artery disease and valvular heart disease usually undergo coronary artery bypass grafting alongside valve replacement or ring repair surgeries. Following these procedures, they typically receive a combination of anticoagulation and antiplatelet therapy, which notably heightens their bleeding risk. However, Current scoring systems provide limited predictive capability.MethodsA total of 500 adult patients treated with anticoagulation plus antiplatelet therapy after cardiac surgery were randomly divided into the training set and the validation set at a ratio of 7:3. Predictive factors were identified using univariate logistic regression, LASSO regression and multivariable analysis. Various models were developed, validated and evaluated by using methods including ROC curves, calibration curves, the Hosmer-Lemeshow test, net reclassification improvement (NRI), integrated discrimination improvement (IDI) index, decision curve analysis (DCA) and clinical impact curves (CIC).ResultsMod2 showed the best performance (AUC of validation set = 0.863) which consists of 8 independent predictive factors (gender, age > 65 years, diabetes, anemia, atrial fibrillation, cardiopulmonary bypass time, intraoperative bleeding and postoperative drainage), with a significantly higher AUC compared to Mod1 (only preoperative factors) and Mod3 (the HAS-BLED scoring model). NRI and IDI analyses further confirmed the superior predictive ability of Mod2 (NRI < 0.05, IDI < 0.05). Both DCA and CIC indicated that Mod2 exhibited good clinical applicability.ConclusionThis research established and validated a nomogram model incorporating eight predictive factors to evaluate the bleeding risk in patients who receive anticoagulation combined with antiplatelet therapy following cardiac surgery. The model holds significant potential for clinical applications in bleeding risk assessment, decision-making and personalized treatment strategies. |
| format | Article |
| id | doaj-art-492088ed90314036b28c1c83ef713c35 |
| institution | Kabale University |
| issn | 1663-9812 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj-art-492088ed90314036b28c1c83ef713c352025-01-07T06:40:52ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-01-011510.3389/fphar.2024.15283901528390Doctor, what is my risk of bleeding after cardiac surgery while on combined anticoagulant with antiplatelet therapy? A validated nomogram for risk assessmentHaolong Han0Haolong Han1Hang Xu2Hang Xu3Jifan Zhang4Weihui Zhang5Yi Yang6Xia Wang7Li Wang8Dongjin Wang9Weihong Ge10School of Pharmacy, Faculty of Medicine, Macau University of Science and Technology, Macau, ChinaDepartment of Pharmacy, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, ChinaSchool of Pharmacy, Faculty of Medicine, Macau University of Science and Technology, Macau, ChinaDepartment of Pharmacy, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, ChinaNanjing Foreign Language School, Nanjing, ChinaDepartment of Pharmacy, Nanjing Drum Tower Hospital, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, ChinaDepartment of Pharmacy, Nanjing Drum Tower Hospital, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, ChinaDepartment of Pharmacy, Nanjing Drum Tower Hospital, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, ChinaSchool of Business, Nanjing University, Nanjing, ChinaDepartment of Cardiothoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, ChinaDepartment of Pharmacy, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, ChinaBackgroundPatients with comorbid coronary artery disease and valvular heart disease usually undergo coronary artery bypass grafting alongside valve replacement or ring repair surgeries. Following these procedures, they typically receive a combination of anticoagulation and antiplatelet therapy, which notably heightens their bleeding risk. However, Current scoring systems provide limited predictive capability.MethodsA total of 500 adult patients treated with anticoagulation plus antiplatelet therapy after cardiac surgery were randomly divided into the training set and the validation set at a ratio of 7:3. Predictive factors were identified using univariate logistic regression, LASSO regression and multivariable analysis. Various models were developed, validated and evaluated by using methods including ROC curves, calibration curves, the Hosmer-Lemeshow test, net reclassification improvement (NRI), integrated discrimination improvement (IDI) index, decision curve analysis (DCA) and clinical impact curves (CIC).ResultsMod2 showed the best performance (AUC of validation set = 0.863) which consists of 8 independent predictive factors (gender, age > 65 years, diabetes, anemia, atrial fibrillation, cardiopulmonary bypass time, intraoperative bleeding and postoperative drainage), with a significantly higher AUC compared to Mod1 (only preoperative factors) and Mod3 (the HAS-BLED scoring model). NRI and IDI analyses further confirmed the superior predictive ability of Mod2 (NRI < 0.05, IDI < 0.05). Both DCA and CIC indicated that Mod2 exhibited good clinical applicability.ConclusionThis research established and validated a nomogram model incorporating eight predictive factors to evaluate the bleeding risk in patients who receive anticoagulation combined with antiplatelet therapy following cardiac surgery. The model holds significant potential for clinical applications in bleeding risk assessment, decision-making and personalized treatment strategies.https://www.frontiersin.org/articles/10.3389/fphar.2024.1528390/fullcoronary artery bypass graftingsurgical valve surgeryanticoagulation combined with antiplateletnomogrambleeding risk |
| spellingShingle | Haolong Han Haolong Han Hang Xu Hang Xu Jifan Zhang Weihui Zhang Yi Yang Xia Wang Li Wang Dongjin Wang Weihong Ge Doctor, what is my risk of bleeding after cardiac surgery while on combined anticoagulant with antiplatelet therapy? A validated nomogram for risk assessment Frontiers in Pharmacology coronary artery bypass grafting surgical valve surgery anticoagulation combined with antiplatelet nomogram bleeding risk |
| title | Doctor, what is my risk of bleeding after cardiac surgery while on combined anticoagulant with antiplatelet therapy? A validated nomogram for risk assessment |
| title_full | Doctor, what is my risk of bleeding after cardiac surgery while on combined anticoagulant with antiplatelet therapy? A validated nomogram for risk assessment |
| title_fullStr | Doctor, what is my risk of bleeding after cardiac surgery while on combined anticoagulant with antiplatelet therapy? A validated nomogram for risk assessment |
| title_full_unstemmed | Doctor, what is my risk of bleeding after cardiac surgery while on combined anticoagulant with antiplatelet therapy? A validated nomogram for risk assessment |
| title_short | Doctor, what is my risk of bleeding after cardiac surgery while on combined anticoagulant with antiplatelet therapy? A validated nomogram for risk assessment |
| title_sort | doctor what is my risk of bleeding after cardiac surgery while on combined anticoagulant with antiplatelet therapy a validated nomogram for risk assessment |
| topic | coronary artery bypass grafting surgical valve surgery anticoagulation combined with antiplatelet nomogram bleeding risk |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2024.1528390/full |
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