Intensification of anticoagulation therapy

Oct 13, 2025 by windailys.com 126 views

Orbit Score as a Predictor of Major Cardiovascular Events and Bleeding in Patients with Acute Myocardial Infarction of ST Segment Elevation Undergoing Percutaneous Coronary Intervention at H. Adam Malik Hospital Medan

Introduction

Acute myocardial infarction of ST segment elevation (STEMI) is a life-threatening condition that requires immediate medical attention. Patients diagnosed with STEMI are at high risk of experiencing major cardiovascular events (MACE) in the future, even after receiving reperfusion therapy and optimal medical treatment. Percutaneous coronary intervention (PCI) is a common treatment for STEMI, but it also carries a risk of bleeding. Orbit score is a new score system used to assess the risk of bleeding in patients with atrial fibrillation (AF) who receive anticoagulants, but its role in predicting MACE in the case of STEMI is still very rare, especially in Indonesia.

Background

STEMI is a condition where the blood flow to the heart is blocked, causing damage to the heart muscle. Percutaneous coronary intervention (PCI) is a minimally invasive procedure used to open up the blocked coronary artery and restore blood flow to the heart. However, PCI also carries a risk of bleeding, which can be life-threatening. Orbit score is a new score system that has been developed to assess the risk of bleeding in patients with AF who receive anticoagulants. The score takes into account various factors, including the patient's age, sex, and medical history.

Methodology

This study aimed to determine the relationship between the orbit score as a MACE predictor and bleeding during inpatients in STEMI patients who undergo PCI. This study was an ambustive observational cohort analysis in 120 samples diagnosed with STEMI and received PCI as reperfusion therapy at H. Adam Malik Hospital Medan. All subjects undergoing PCI were calculated their orbit scores, then observed during inpatient. The monitored output was the events of MACE and bleeding during inpatients. The predictive value of the orbit score was analyzed using the ROC curve.

Results

Of the 120 samples included in this study, 34 patients (30%) experienced MACE. Orbit scores were higher in groups that experience MACE (p <0.001). The results of the ROC analysis showed the orbit score had a good ability to predict MACE (AUC: 0.852, 95% CI: 0.771-0.932 P <0.001). There was a statistically significant relationship between the orbit score and each Mace, namely death, cardiogenic shock, acute heart failure, and malignant arrhythmia with a p <0.05 value. There were 14 patients (11.6%) who experience bleeding. The orbit score had a predictive ability to predict the incidence of bleeding (AUC 0.728 95% CI: 0.570-0.886 P <0.001).

Discussion

The results of this study showed that the orbit score can be used as a MACE predictor and bleeding during inpatients in STEMI patients who undergo PCI. This shows the potential orbit score as a clinical aid to identify STEMI patients who are at high risk of experiencing MACE and bleeding, so that the right prevention and intervention strategies can be carried out. This study provides important information for health practitioners in Indonesia, especially in the field of cardiology. The ability to score orbits in predicting MACE and bleeding in STEMI patients undergoing PCI can help in making clinical decisions, monitoring, and more directed treatment strategies.

Conclusion

Limitations

However, this research has several limitations, such as observational design that does not allow the determination of causal relationships. Further research with a stronger design and involving a larger sample is needed to confirm the results of this study and explore other factors that can affect MACE predictions and bleeding in STEMI patients.

Future Directions

Future studies should aim to confirm the results of this study and explore other factors that can affect MACE predictions and bleeding in STEMI patients. Additionally, the orbit score should be validated in other populations and settings to ensure its generalizability. The development of a clinical decision support system that incorporates the orbit score could also be explored to aid healthcare providers in making informed decisions about STEMI patients.

Implications

The implications of this study are significant, as it provides a new tool for healthcare providers to identify STEMI patients who are at high risk of experiencing MACE and bleeding. The orbit score can be used to guide clinical decisions, such as the intensity of anticoagulation therapy and the need for closer monitoring. Additionally, the orbit score can be used to identify patients who may benefit from more aggressive treatment strategies, such as the use of antiplatelet agents or anticoagulants.

Recommendations

Based on the results of this study, the following recommendations are made:

Use of the orbit score: The orbit score should be used as a clinical aid to identify STEMI patients who are at high risk of experiencing MACE and bleeding.
Intensification of anticoagulation therapy: Patients with high orbit scores should be considered for more aggressive anticoagulation therapy, such as the use of antiplatelet agents or anticoagulants.
Closer monitoring: Patients with high orbit scores should be closely monitored for signs of MACE and bleeding.
Development of a clinical decision support system: A clinical decision support system that incorporates the orbit score should be developed to aid healthcare providers in making informed decisions about STEMI patients.

Conclusion

In conclusion, the orbit score can be used as a MACE predictor and bleeding during inpatients in STEMI patients who undergo PCI. This shows the potential orbit score as a clinical aid to identify STEMI patients who are at high risk of experiencing MACE and bleeding, so that the right prevention and intervention strategies can be carried out.
Orbit Score as a Predictor of Major Cardiovascular Events and Bleeding in Patients with Acute Myocardial Infarction of ST Segment Elevation Undergoing Percutaneous Coronary Intervention at H. Adam Malik Hospital Medan: Q&A

Q: What is the orbit score and how is it used?

A: The orbit score is a new score system used to assess the risk of bleeding in patients with atrial fibrillation (AF) who receive anticoagulants. It takes into account various factors, including the patient's age, sex, and medical history. In this study, the orbit score was used to predict major cardiovascular events (MACE) and bleeding in patients with acute myocardial infarction of ST segment elevation (STEMI) who underwent percutaneous coronary intervention (PCI).

Q: What are the limitations of this study?

A: This study has several limitations, including an observational design that does not allow the determination of causal relationships. Further research with a stronger design and involving a larger sample is needed to confirm the results of this study and explore other factors that can affect MACE predictions and bleeding in STEMI patients.

Q: What are the implications of this study?

A: The implications of this study are significant, as it provides a new tool for healthcare providers to identify STEMI patients who are at high risk of experiencing MACE and bleeding. The orbit score can be used to guide clinical decisions, such as the intensity of anticoagulation therapy and the need for closer monitoring.

Q: How can the orbit score be used in clinical practice?

A: The orbit score can be used as a clinical aid to identify STEMI patients who are at high risk of experiencing MACE and bleeding. It can be used to guide clinical decisions, such as the intensity of anticoagulation therapy and the need for closer monitoring. Additionally, the orbit score can be used to identify patients who may benefit from more aggressive treatment strategies, such as the use of antiplatelet agents or anticoagulants.

Q: What are the potential benefits of using the orbit score in clinical practice?

A: The potential benefits of using the orbit score in clinical practice include:

Improved identification of STEMI patients who are at high risk of experiencing MACE and bleeding
More targeted and effective treatment strategies
Reduced risk of bleeding and MACE in STEMI patients
Improved patient outcomes and quality of life

Q: What are the potential challenges of implementing the orbit score in clinical practice?

A: The potential challenges of implementing the orbit score in clinical practice include:

Limited availability of data on the orbit score
Limited understanding of the orbit score and its application in clinical practice
Potential for bias in the application of the orbit score
Need for further research to confirm the results of this study and explore other factors that can affect MACE predictions and bleeding in STEMI patients

Q: What are the next steps for further research on the orbit score?

A: The next steps for further research on the orbit score include:

Confirming the results of this study and exploring other factors that can affect MACE predictions and bleeding in STEMI patients
Developing a clinical decision support system that incorporates the orbit score
Validating the orbit score in other populations and settings
Exploring the potential benefits and challenges of implementing the orbit score in clinical practice

Q: What are the potential applications of the orbit score in other areas of medicine?

A: The potential applications of the orbit score in other areas of medicine include:

Predicting MACE and bleeding in patients with other types of cardiovascular disease
Identifying patients who are at high risk of experiencing MACE and bleeding in other medical conditions
Developing targeted and effective treatment strategies for patients who are at high risk of experiencing MACE and bleeding

Q: What are the potential limitations of the orbit score in other areas of medicine?

A: The potential limitations of the orbit score in other areas of medicine include:

Limited availability of data on the orbit score
Limited understanding of the orbit score and its application in clinical practice
Potential for bias in the application of the orbit score
Need for further research to confirm the results of this study and explore other factors that can affect MACE predictions and bleeding in STEMI patients.