Cosín-Sales Juan, Anguita Sánchez Manuel, Suárez Carmen, Arias-Cabrales Carlos, Martínez-Sanchez Luisa, Arumi Daniel, Fernández de Cabo Susana
Cardiology Department, Arnau de Vilanova Hospital, 46015 Valencia, Spain.
Faculty of Medicine, CEU-Cardenal Herrera University, Alfara del Patriaca, 46115 Valencia, Spain.
J Clin Med. 2024 Oct 18;13(20):6226. doi: 10.3390/jcm13206226.
We assessed the effectiveness and safety of vitamin K antagonists (VKAs) versus direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) using artificial intelligence techniques. This is a retrospective study in 15 Spanish hospitals (2014-2020), including adult AF patients with no history of anticoagulation, thrombosis events, rheumatic mitral valvular heart disease, mitral valve stenosis, or pregnancy. We employed EHRead technology based on natural language processing (NLP) and machine learning (ML), along with SNOMED-CT terminology, to extract clinical data from electronic health records (EHRs). Using propensity score matching (PSM), the effectiveness, safety, and hospital mortality of VKAs versus DOACs were analyzed through Kaplan-Meier curves and Cox regression. Out of 138,773,332 EHRs from 4.6 million individuals evaluated, 44,292 patients were included, 79.6% on VKAs and 20.4% on DOACs. Most patients were elderly [VKA 78 (70, 84) and DOAC 75 (66, 83) years], with numerous comorbidities (75.5% and 70.2% hypertension, 47.2% and 39.9% diabetes, and 40.3% and 34.8% heart failure, respectively). Additionally, 60.4% of VKA and 48.7% of DOAC users had a CHA2DS2-VASc Score ≥4. After PSM, 8929 patients per subgroup were selected. DOAC users showed a lower risk of thrombotic events [HR 0.81 (95% CI 0.70-0.94)], minor bleeding [HR 0.89 (95% CI 0.83-0.96)], and mortality [HR 0.80 (95% CI 0.69-0.92)]. Applying NLP and ML, we generated valuable real-world evidence on anticoagulated AF patients in Spain. Even in complex populations, DOACs have demonstrated a better safety and effectiveness profile than VKAs.
我们使用人工智能技术评估了维生素K拮抗剂（VKA）与直接口服抗凝剂（DOAC）在心房颤动（AF）患者中的有效性和安全性。这是一项在15家西班牙医院进行的回顾性研究（2014 - 2020年），纳入了无抗凝治疗史、血栓形成事件、风湿性二尖瓣心脏病、二尖瓣狭窄或妊娠的成年AF患者。我们采用基于自然语言处理（NLP）和机器学习（ML）的EHRead技术以及SNOMED - CT术语，从电子健康记录（EHR）中提取临床数据。使用倾向得分匹配（PSM），通过Kaplan - Meier曲线和Cox回归分析了VKA与DOAC的有效性、安全性和医院死亡率。在评估的460万个体的138773332份EHR中，纳入了44292例患者，79.6%使用VKA，20.4%使用DOAC。大多数患者为老年人[VKA组78（70，84）岁，DOAC组75（66，83）岁]，有多种合并症（高血压分别为75.5%和70.2%，糖尿病分别为47.2%和39.9%，心力衰竭分别为40.3%和34.8%）。此外，60.4%的VKA使用者和48.7%的DOAC使用者CHA2DS2 - VASc评分≥4。PSM后，每个亚组选择了8929例患者。DOAC使用者的血栓形成事件风险较低[风险比（HR）0.81（95%置信区间0.70 - 0.94）]，轻微出血风险较低[HR 0.89（95%置信区间0.83 - 0.96）]，死亡率较低[HR 0.80（95%置信区间0.69 - 0.92）]。通过应用NLP和ML，我们生成了关于西班牙抗凝治疗AF患者的有价值的真实世界证据。即使在复杂人群中，DOACs已证明比VKA具有更好的安全性和有效性。
