The Applicability of Novel Predictor of Intracranial Hemorrhage in Patients With Atrial Fibrillation in the Contemporary Real-World Clinical Practice

IF 2.4 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Naoya Kataoka, Teruhiko Imamura
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引用次数: 0

Abstract

Major bleeding, including intracranial hemorrhage (ICH), is a significant complication in patients with non-valvular atrial fibrillation (NVAF) undergoing treatment with oral anticoagulants (OACs). The authors proposed a novel risk score for predicting ICH in NVAF patients, incorporating variables such as age, sex, nonsmoking status, renal replacement therapy, and OAC use [1]. However, several critical concerns merit discussion.

The authors compared their proposed risk score with the established HAS-BLED score [1], a widely utilized tool for predicting not only ICH but also other major bleeding events classified as ≥ BARC 3b [2]. Unlike the novel score, the HAS-BLED score includes parameters such as hepatic dysfunction and the use of antiplatelet agents. Consequently, employing the HAS-BLED score as a comparator may not fully capture the nuances of the novel score's predictive capability for ICH specifically.

Patients with NVAF are susceptible to a range of complications, including thromboembolic events and heart failure. A noteworthy concern is the potential applicability of the novel risk score in predicting these broader complications. Furthermore, in the authors' study, only 6.7% of the cohort were treated with direct oral anticoagulants (DOACs) [1], which currently represent the predominant class of anticoagulants in clinical practice [3]. This limited representation raises questions about the generalizability of the score to patients receiving DOACs, warranting further validation.

Additionally, prior literature advises against the use of OACs in patients undergoing renal replacement therapy due to heightened bleeding risks [4]. Excluding such patients from the construction of risk scores may be more appropriate to ensure clinical relevance and applicability.

The authors have nothing to report.

The authors have nothing to report.

The authors declare no conflicts of interest.

心房颤动患者颅内出血新预测因子在当代现实世界临床实践中的适用性
大出血,包括颅内出血(ICH),是接受口服抗凝剂(OACs)治疗的非瓣膜性心房颤动(NVAF)患者的一个重要并发症。作者提出了一种新的预测非瓣瓣性房颤患者脑出血的风险评分方法,包括年龄、性别、不吸烟状况、肾脏替代治疗和OAC使用[1]等变量。然而,有几个关键问题值得讨论。作者将他们提出的风险评分与已建立的ha - bled评分[1]进行了比较,后者是一种广泛使用的工具,不仅可预测脑出血,还可预测其他分类≥BARC 3b[1]的主要出血事件。与新评分不同,HAS-BLED评分包括肝功能障碍和抗血小板药物使用等参数。因此,采用HAS-BLED评分作为比较指标可能无法完全捕捉到新评分对ICH预测能力的细微差别。非瓣膜性房颤患者易发生一系列并发症,包括血栓栓塞事件和心力衰竭。值得关注的是,新的风险评分在预测这些更广泛的并发症方面的潜在适用性。此外,在作者的研究中,只有6.7%的队列患者接受了直接口服抗凝剂(DOACs)[1]治疗,而DOACs目前是临床应用中主要的抗凝剂[3]。这种有限的代表性提出了对接受doac的患者评分的普遍性的问题,需要进一步验证。此外,由于出血风险增加,先前的文献建议在接受肾脏替代治疗的患者中不要使用OACs。将此类患者排除在风险评分的构建之外可能更适合于确保临床相关性和适用性。作者没有什么可报告的。作者没有什么可报告的。作者声明无利益冲突。
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来源期刊
Clinical Cardiology
Clinical Cardiology 医学-心血管系统
CiteScore
5.10
自引率
3.70%
发文量
189
审稿时长
4-8 weeks
期刊介绍: Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.
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