摘要
Abstract
Objective To investigate the influencing factors for over-anticoagulation in patients with atrial fibrillation receiving warfarin anticoagulation therapy and establish a Nomogram-based risk prediction model for over-anticoagulation.Methods Data of 278 patients with atrial fibrillation treated at Lishui Central Hospital from February 2019 to February 2022 were retrospectively collected.Patients were divided into an over-anticoagulation group(n=83)and a non-over-anticoagulation group(n=195)based on whether over-anticoagulation occurred during warfarin anticoagulation treatment.Logistic regression analysis was performed to identify factors influencing over-anticoagulation,and a Nomogram risk prediction model was developed.The discrimination and calibration of the prediction model were evaluated using the ROC and calibration curves.Results The incidence of over-anticoagulation during warfarin anticoagulation treatment in patients with atrial fibrillation was 29.86%(83/278).Univariate analysis results indicated significant differences in age(χ2=4.544,P<0.05),body mass index(BMI)(χ2=5.199,P<0.05),concomitant use of nonsteroidal anti-inflammatory drugs(NSAIDs)(χ2=25.134,P<0.05),early international normalized ratio(INR)(χ2=38.421,P<0.05),and hypoalbuminemia(χ2=5.348,P<0.05).Multivariate logistic regression analysis revealed that age≥60 years(OR=3.305,P<0.05),BMI≥24 kg/m2(OR=5.163,P<0.05),concomitant use of NSAIDs(OR=6.643,P<0.05),and early INR>1.67(OR=4.596,P<0.05)were independent risk factors for over-anticoagulation,while lack of hypoalbuminemia(OR=0.179,P<0.05)was a protective factor.The ROC analysis of the Nomogram model showed an AUC of 0.825(95%CI=0.775-0.874),with an optimal cutoff value of 0.601,sensitivity of 0.867,and specificity of 0.733.The calibration curve demonstrated good consistency between theoretical and actual values(χ2=7.995,P>0.05).Conclusion Patients with atrial fibrillation aged≥60 years,with BMI≥24 kg/m2,concomitant NSAIDs use,early INR>1.67,and hypoalbuminemia should have their INR levels closely monitored during warfarin anticoagulation therapy to minimize and prevent over-anticoagulation.The Nomogram-based risk prediction model provides a more accurate method for identifying high-risk patients,guiding individualized monitoring and management strategies.关键词
心房颤动/华法林/抗凝过度/Nomogram预测模型Key words
Atrial fibrillation/Warfarin/Over anticoagulation/Nomogram prediction model
