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Prediction of the Possibility of Hemorrhagic Syndrome during Combined Antiplatelet Therapy According to the Krasnodar Region Registry

https://doi.org/10.20996/1819-6446-2019-15-5-697-705

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Abstract

Background. According to the literature data, acute coronary syndrome (ACS) in 2-20 % of cases is combined with atrial fibrillation (AF). According to the current guidelines of the European Society of Cardiology (ESC), patients with coexisting AF and ACS should receive dual antiplatelet therapy for the prevention of recurrent cardiovascular events and anticoagulant therapy for the prevention of thromboembolic complications. However, this combination is fraught with the development of hemorrhagic syndrome.

Aim. To develop a model and software module for predicting possible bleeding in patients with ACS combined with AF taking three-component antithrombotic therapy.

Materials and Methods. To build prognostic models for the development of hemorrhagic syndrome, a statistical method was used for classification trees and the neural network procedure implemented in the STATISTICA package. To build prognostic models, a sample was used consisting of 201 patients with a combination of ACS and AF with and without fatal outcome, the state of which was described by 42 quantitative and qualitative clinical indicators. The control group included 205 patients with ACS and intact sinus rhythm.

Results. To identify predictors of predictive models of the possible development of hemorrhagic syndrome in patients with triple antithrombotic therapy, the Spearman correlation coefficient was used. The study of correlations allowed to reveal clinical indicators – predictors of prognostic models. After analyzing the predictive ability of the developed models, a software module was created in the Microsoft Visual C # 2015 programming environment that allows determining the possibility of hemorrhagic syndrome in patients with a combination of ACS and AF using classification trees and neural networks.

Сonclusion. A classification model and a software module were developed to predict possible bleeding in patients taking three-component antithrombotic therapy. Models contain both quantitative and qualitative (categorical) clinical indicators. The current level of development of data analysis technologies opens up broad horizons for medicine in solving problems on real medical data, without translating them into scoring risk scales, including prediction of the diagnosis of the disease, stage of the disease, treatment outcome, possible complications, etc. High reliability of such systems can be provided by large volumes of medical data accumulated on servers. 

About the Authors

Z. G. Tatarintseva
Research Institute – Ochapovsky Regional Clinical Hospital №1
Russian Federation

MD, Cardiologist, Head of Cardiology Department №4,

Pervogo Maya ul. 167, Krasnodar, 350029



E. D. Kosmacheva
Research Institute – Ochapovsky Regional Clinical Hospital №1; Kuban State University
Russian Federation

Deputy Chief Physician, Pervogo Maya ul. 167, Krasnodar, 350029;

MD, PhD, Professor, Head of Chair of Therapy №1, Sedina ul. 4, Krasnodar, 350063



S. V. Kruchinova
Research Institute – Ochapovsky Regional Clinical Hospital №1; Kuban State University
Russian Federation

Cardiologist, Pervogo Maya ul. 167, Krasnodar, 350029;

MD, Postgraduate Student, Chair of Therapy №1, Sedina ul. 4, Krasnodar, 350063



V. A. Akinshina
Kuban State University
Russian Federation

PhD (Pedagogics), Associate Professor, Chair of Applied Mathematics, 

Sedina ul. 4, Krasnodar, 350063



A. A. Khalafyan
Kuban State University
Russian Federation

PhD (Technical), Professor, Chair of Applied Mathematics,

Sedina ul. 4, Krasnodar, 350063



References

1. Jabre P., Roger V.L., Murad M.H., et al. Mortality associated with atrial fibrillation in patients with myocardial infarction: a systematic review and meta-analysis. Circulation. 2011;123:1587-93. DOI:10.1161/CIRCULATIONAHA.110.986661.

2. ACC/AHA Task Force Members. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130:199-267. DOI: 10.1161/CIR.0000000000000041.

3. Hansen M.L., Sorensen R., Clausen M.T., et al. Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation. Arch Intern Med. 2010;170:1433- 41. DOI:10.1001/archinternmed.2010.271.

4. Persson J., Lindbaeck J., Hofman-Bang C., et al. Efficacy and safety of clopidogrel after PCI with stenting in patients on oral anticoagulants with acute coronary syndrome. Euro Intervention. 2011;6:1046- 52. DOI:10.4244/EIJV6I9A183.

5. Guasch E., Sionis A., Reverter J.C., et al. Safety issues of adjunctive clopidogrel in patients discharged after percutaneous coronary intervention with stent placement and requiring oral anticoagulation. Int J Cardiol. 2011;146:e1-e4. DOI:10.1016/j.ijcard.2008.12.170.

6. Gao F., Zhou Y.J., Wang Z.J., et al. Comparison of Different Antithrombotic Regimens for Patients with Atrial Fibrillation Undergoing Drug-Eluting Stent Implantation. Circ J. 2010;74:701-8. DOI:10.1253/circj.CJ-09-0880.

7. Zhao H.J., Zheng Z.T., Wang Z.H., et al. “Triple Therapy” Rather Than “Triple Threat” A Meta-analysis of the Two Antithrombotic Regimens After Stent Implantation in Patients Receiving Long-term Oral Anticoagulant Treatment. Chest. 2011;139(2):260-70. DOI:10.1378/chest.09-3083.

8. Maegdefessel L., Schlitt A., Faerber J., et al. Anticoagulant and/or antiplatelet treatment in patients with atrial fibrillation after percutaneous coronary intervention. A single-center experience. Med Klin (Munich). 2008;103(9):628-32. DOI:10.1007/s00063-008-1101-4.

9. Rubboli A., Halperin J.L. Antithrombotic therapy with warfarin, aspirin and clopidogrel is the recommended regime in anticoagulated patients who present with an acute coronary syndrome and/or undergo percutaneous coronary interventions. Thromb Haemost. 2008;100(5):752-3.

10. DeEugenio D., Kolman L., DeCaro M., et al. Risk of major bleeding with concomitant dual antiplatelet therapy after percutaneous coronary intervention in patients receiving long-term warfarin therapy. Pharmacoherapy. 2007;27(5):691-6. DOI:10.1592/phco.27.5.691.

11. Rubboli A., Colletta M., Herzfeld J., et al. Peri-procedural and medium-term antithrombotic strategies in patients with an indication for long-term anticoagulation undergoing coronary angiography and intervention. Coron Artery Dis. 2007;18:193-9. DOI:10.1097/MCA.0b013e328012a964.

12. Authors/Task Force Members, Camm A.J., Lip G.Y., De Caterina R., et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012;33(21):2719-47. DOI:10.1093/eurheartj/ehs253.

13. Pisters R., Lane D.A., Nieuwlaat R., et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138(5):1093-100. DOI:10.1378/chest.10-0134.

14. Khalafyan A.A. STATISTICA 6. Mathematical statistics with elements of probability theory. Moscow: Binom; 2010 (In Russ.)

15. Borovikov V.P., ed. Neural networks STATISTICA Neural Networks. Methodology and technologies of modern data analysis: a textbook (2nd ed.). Moscow: Hot Line - Telecom; 2008 (In Russ.)


For citation:


Tatarintseva Z.G., Kosmacheva E.D., Kruchinova S.V., Akinshina V.A., Khalafyan A.A. Prediction of the Possibility of Hemorrhagic Syndrome during Combined Antiplatelet Therapy According to the Krasnodar Region Registry. Rational Pharmacotherapy in Cardiology. 2019;15(5):697-705. (In Russ.) https://doi.org/10.20996/1819-6446-2019-15-5-697-705

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)