Brinza Crischentian, Burlacu Alexandru, Tinica Grigore, Covic Adrian, Macovei Liviu
Institute of Cardiovascular Diseases "Prof. Dr. George I.M. Georgescu", 700503 Iasi, Romania.
Faculty of Medicine, University of Medicine and Pharmacy "Grigore T Popa", 700115 Iasi, Romania.
Healthcare (Basel). 2021 Feb 2;9(2):148. doi: 10.3390/healthcare9020148.
Dual antiplatelet therapy (DAT) is recommended for all patients undergoing percutaneous coronary intervention (PCI), as it significantly reduces the ischemic risk at the cost of increasing the incidence of bleeding events. Several clinical predictive models were developed to better stratify the bleeding risk associated with DAT. This systematic review aims to perform a literature survey of both standard and emerging bleeding risk scores and report their performance on predicting hemorrhagic events, especially in the era of second-generation drug-eluting stents and more potent P2Y12 inhibitors. We searched PubMed, ScienceDirect, and Cochrane databases for full-text studies that developed or validated bleeding risk scores in adult patients undergoing PCI with subsequent DAT. The risk of bias for each study was assessed using the prediction model risk of bias assessment tool (PROBAST). Eighteen studies were included in the present systematic review. Bleeding risk scores showed a modest to good discriminatory power with c-statistic ranging from 0.49 (95% CI, 0.45-0.53) to 0.82 (95% CI, 0.80-0.85). Clinical models that predict in-hospital bleeding events had a relatively good predictive performance, with c-statistic ranging from 0.70 (95% CI, 0.67-0.72) to 0.80 (95% CI, 0.73-0.87), depending on the risk scores and major hemorrhagic event definition used. The knowledge and utilization of the current bleeding risk scores in appropriate clinical contexts could improve the prediction of bleeding events.
双联抗血小板治疗（DAT）被推荐用于所有接受经皮冠状动脉介入治疗（PCI）的患者，因为它能显著降低缺血风险，但代价是增加出血事件的发生率。人们开发了几种临床预测模型，以更好地对与DAT相关的出血风险进行分层。本系统评价旨在对标准和新出现的出血风险评分进行文献调查，并报告它们在预测出血事件方面的表现，特别是在第二代药物洗脱支架和更强效的P2Y12抑制剂时代。我们在PubMed、ScienceDirect和Cochrane数据库中搜索了全文研究，这些研究开发或验证了接受PCI并随后进行DAT的成年患者的出血风险评分。使用预测模型偏倚风险评估工具（PROBAST）评估每项研究的偏倚风险。本系统评价纳入了18项研究。出血风险评分显示出中等至良好的区分能力，c统计量范围为0.49（95%CI，0.45 - 0.53）至0.82（95%CI，0.80 - 0.85）。预测住院期间出血事件的临床模型具有相对较好的预测性能，c统计量范围为0.70（95%CI，0.67 - 0.72）至0.80（95%CI，0.73 - 0.87），这取决于所使用的风险评分和主要出血事件定义。在适当的临床环境中了解和使用当前的出血风险评分可以改善对出血事件的预测。
