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ORIGINAL RESEARCH article

Front. Pharmacol.
Sec. Drugs Outcomes Research and Policies
Volume 15 - 2024 | doi: 10.3389/fphar.2024.1528390
This article is part of the Research Topic Clinical Pharmacist Service Promotes the Improvement of Medical Quality Volume II View all 33 articles

Doctor, what is my risk of bleeding after cardiac surgery while on combined anticoagulant with antiplatelet therapy? A validated nomogram for risk assessment

Provisionally accepted
Haolong Han Haolong Han 1,2*Hang Xu Hang Xu 1,2Jifan Zhang Jifan Zhang 3*Weihui Zhang Weihui Zhang 4*Yi Yang Yi Yang 4*Xia Wang Xia Wang 4*Li Wang Li Wang 5*Dongjin Wang Dongjin Wang 6*Weihong Ge Weihong Ge 2*
  • 1 School of Pharmacy, Faculty of Medicine, Macau University of Science and Technology, Macau SAR, China
  • 2 Department of Pharmacy, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
  • 3 Nanjing Foreign Language School, Nanjing, Jiangsu Province, China
  • 4 School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Department of Pharmacy, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province, China
  • 5 School of Business, Nanjing University, Nanjing, China
  • 6 Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China

The final, formatted version of the article will be published soon.

    Background: Patients with comorbid coronary artery disease and valvular heart disease usually undergo coronary artery bypass grafting alongside valve replacement or ring repair surgeries. Following these procedures, they typically receive a combination of anticoagulation and antiplatelet therapy, which notably heightens their bleeding risk.However, Current scoring systems provide limited predictive capability.Methods: A total of 500 adult patients treated with anticoagulation plus antiplatelet therapy after cardiac surgery were randomly divided into the training set and the validation set at a ratio of 7:3. Predictive factors were identified using univariate logistic regression, LASSO regression and multivariable analysis. Various models were developed, validated and evaluated by using methods including ROC curves, calibration curves, the Hosmer-Lemeshow test, net reclassification improvement (NRI), integrated discrimination improvement (IDI) index, decision curve analysis (DCA) and clinical impact curves (CIC).: Mod2 showed the best performance (AUC of validation set= 0.863) which consists of 8 independent predictive factors (gender, age>65 years, diabetes, anemia, atrial fibrillation, cardiopulmonary bypass time, intraoperative bleeding and postoperative drainage), with a significantly higher AUC compared to Mod1 (only preoperative factors) and Mod3 (the HAS-BLED scoring model). Analyses using NRI and IDI further validated Mod2's superior predictive capability. NRI and IDI analyses further confirmed the superior predictive ability of Mod2(NRI<0.05, IDI<0.05).Both DCA and CIC demonstrated that Mod2 has strong clinical applicability Both DCA and CIC indicated that Mod2 exhibited good clinical applicability. Conclusions: This research established and validated a nomogram model incorporating eight predictive factors to evaluate the bleeding risk in patients who receive anticoagulation combined with antiplatelet therapy following cardiac surgery. The model holds significant potential for clinical applications in bleeding risk assessment, decision-making and personalized treatment strategies.

    Keywords: coronary artery bypass grafting, Surgical valve surgery, Anticoagulation combined with antiplatelet, nomogram, bleeding risk

    Received: 14 Nov 2024; Accepted: 23 Dec 2024.

    Copyright: © 2024 Han, Xu, Zhang, Zhang, Yang, Wang, Wang, Wang and Ge. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Haolong Han, School of Pharmacy, Faculty of Medicine, Macau University of Science and Technology, Macau SAR, China
    Jifan Zhang, Nanjing Foreign Language School, Nanjing, Jiangsu Province, China
    Weihui Zhang, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Department of Pharmacy, Nanjing Drum Tower Hospital, Nanjing, 210008, Jiangsu Province, China
    Yi Yang, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Department of Pharmacy, Nanjing Drum Tower Hospital, Nanjing, 210008, Jiangsu Province, China
    Xia Wang, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Department of Pharmacy, Nanjing Drum Tower Hospital, Nanjing, 210008, Jiangsu Province, China
    Li Wang, School of Business, Nanjing University, Nanjing, China
    Dongjin Wang, Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
    Weihong Ge, Department of Pharmacy, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.