Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.
Clinical Research and Informatics, Ohta Nishinouchi Hospital, Koriyama, Japan.
J Gastroenterol Hepatol. 2018 Jan;33(1):164-171. doi: 10.1111/jgh.13830.
The study developed a predictive model of long-term gastrointestinal (GI) bleeding risk in patients receiving oral anticoagulants and compared it with the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratios, Elderly, Drugs/alcohol concomitantly) score.
The study periodically followed a cohort of 508 patients taking oral anticoagulants (66 direct oral anticoagulants users and 442 warfarin users). Absence of GI bleeding at an initial examination and any subsequent GI bleeding were confirmed endoscopically. The bleeding model was developed by multivariate survival analysis and evaluated by Harrell's c-index.
During a median follow-up of 31.4 months, 42 GI bleeds (8.3%) occurred: 42.8% in the upper GI tract, 50.0% in the lower GI tract, and 7.1% in the middle GI tract. The cumulative 5 and 10-year probability of GI bleeding was 12.6% and 18.5%, respectively. Patients who bled had a significantly higher cumulative incidence of all-cause mortality (hazard ratio 2.9, P < 0.001). Multivariate analysis revealed that absence of proton pump inhibitor therapy, chronic kidney disease, chronic obstructive pulmonary disease, history of peptic ulcer disease, and liver cirrhosis predicted GI bleeding. The c-statistic for the new predictive model using these five factors was 0.65 (P < 0.001), higher than the HAS-BLED score of 0.57 (P = 0.145).
Gastrointestinal bleeding increased the risk of subsequent mortality during follow-up of anticoagulated patients, highlighting the importance of prevention. The study developed a new scoring model for acute GI bleeding risk based on five factors (no-proton pump inhibitor use, chronic kidney disease, chronic obstructive pulmonary disease, history of peptic ulcer disease, and liver cirrhosis), which was superior to the HAS-BLED score.
本研究开发了一种预测口服抗凝剂患者长期胃肠道（GI）出血风险的模型，并将其与 HAS-BLED（高血压、异常肾功能/肝功能、卒中、出血史或倾向、不稳定的国际标准化比值、老年、同时使用药物/酒精）评分进行比较。
该研究定期随访了 508 名服用口服抗凝剂的患者队列（66 名直接口服抗凝剂使用者和 442 名华法林使用者）。在内镜检查中确认初始检查时无 GI 出血和随后任何 GI 出血。通过多变量生存分析开发出血模型，并通过 Harrell 的 c 指数进行评估。
在中位随访 31.4 个月期间，发生了 42 例 GI 出血（8.3%）：42.8%在上消化道，50.0%在下消化道，7.1%在中消化道。5 年和 10 年累积 GI 出血的概率分别为 12.6%和 18.5%。出血患者的全因死亡率累积发生率明显更高（风险比 2.9，P<0.001）。多变量分析显示，质子泵抑制剂治疗缺失、慢性肾脏病、慢性阻塞性肺疾病、消化性溃疡病史和肝硬化预测了 GI 出血。使用这五个因素的新预测模型的 c 统计量为 0.65（P<0.001），高于 HAS-BLED 评分 0.57（P=0.145）。
在接受抗凝治疗的患者随访期间，胃肠道出血增加了随后死亡的风险，这突出了预防的重要性。该研究基于五个因素（无质子泵抑制剂使用、慢性肾脏病、慢性阻塞性肺疾病、消化性溃疡病史和肝硬化）开发了一种新的急性 GI 出血风险评分模型，优于 HAS-BLED 评分。
