Evaluation Of The Risk Of Anticoagulant Hemorrhage In Patients With Venous Thromboembolism By Direct Oral Anticoagulant Therapy With VTE-BLEED Score And Establishment Of Related Predictive Model

ObjectiveThe aim of this study was to validate the feasibility of the VTE-bled scale in predicting the risk of bleeding in patients with venous thromboembolism（VTE）using direct oral anticoagulants（DOACs）,objective: to study the influence of laboratory indexes of coagulation function on bleeding events induced by DOACs anticoagulation,and to establish the risk prediction model of DOACs anticoagulation in patients with VTE.MethodsIn this study,prospective Case-control study method was used to screen VTE patients with anticoagulation therapy from January to November in the affiliated hospital of 2021,according to the criteria of admission and exclusion.The patients were divided into groups according to the score of VTE-BLEED scale.The patients were treated with DOACs under the guidance of professional doctors and followed up for 3months.The difference of bleeding rate between low-risk group and high-risk Group was calculated to verify the validity of vte-bled scale.The coagulation indexes of the two groups were compared,and the ROC curve was used to calculate the best critical value,Yoden index,sensitivity and specificity.On this basis,logistic regression analysis was used to establish the relevant prediction model.Data analysis was performed with SPSS25.0 software.ResultsIn this study,157 VTE patients were selected and divided into high-risk Group（47cases）and low-risk group（110 cases）,the difference of bleeding rate between high risk group and low risk group was statistically significant（p < 0.05）.There was no significant difference in TT,FIB,FDP,D-Dimer,AT III between hemorrhage group and non-hemorrhage group（p > 0.05）.There were significant differences in Plt,PT,INR and APTT between the two groups（p < 0.05）.PT,INR,Aptt had positive correlation with DOACs anticoagulant bleeding events,PLT had negative correlation with DOACs anticoagulant bleeding events,the best critical value of Aptt was 26.35 seconds,the Yoden index was 0.31,the sensitivity was 76.7%,the specificity was 54.3%;The best critical value of PT is 11.35 seconds,the Yorden index is 0.316,the sensitivity is 73.3%,the specificity is 58.3%,the best critical value of INR is 0.965,the Yorden index is0.308,the sensitivity is 73.3%,the specificity is 57.5%.The optimum critical value of Plt is 247.5 * 10 ^ 9/l,the Yorden index is 0.265,the sensitivity is 46.5%,and the specificity is 80.0%.The Hosmer-lemarchal test of the final prediction model p = 0.809.The total accuracy,sensitivity and specificity of the model were97.6% and 13.3%.The overall accuracy was 81.5%Conclusion1.The VTE-BLEED scoring scale scoring scale is feasible for predicting the risk of anticoagulant bleeding in patients with VTE using DOACs.2.Plt,PT,Aptt,TT,FIB,FDP,INR,D-Dimer,AT III and other indexes correlated with DOACs bleeding events to some extent,but not as an independent risk factor.3.VTE-BLEED score combined with coagulation index is poor specificity.It needs to be improved.