Although the occurrence of bleeding events may have a significant impact on the prognosis of patients with stent-assisted embolization of aneurysms, current studies have only pointed out the parameters that may be associated with TEG and bleeding events. We developed and internally validated a nomogram combining BMI, AAi, and MA-ADP to predict the probability of a patient's bleeding event after stent-assisted aneurysm embolization, internal validity, and discrimination Satisfactory power.
To our knowledge, this is the first study to use nomograms to predict postoperative bleeding events in patients with stent-assisted embolization of aneurysms. In this study, about 22% of patients experienced bleeding events, and our study showed that BMI, AAi, and MA-ADP could be used as predictors of bleeding events in Chinese patients. However, the incidence of allelic variants associated with clopidogrel activity is higher in Western populations than in East Asian populations, and at the same time, Western populations have more types of allelic variants[17, 18]. So for Western populations, the influencing factors may be different.
Studies have shown that for patients with intracranial stent placement, there is no statistically significant difference in MA-ADP between the bleeding event group and the non-bleeding event group. They believe that TEG-PM is almost no predictor of bleeding complications in such patients’ roles [19]. Another study also pointed out that TEG parameters were not found to be associated with bleeding complications in patients [20]. This is in stark contrast to our findings, which suggest that the associated parameters combined with TEG can predict the probability of bleeding complications in this patient. A study by Ge, H et al. [21] showed that there was a statistically significant difference between ADPi and MA-ADP between the bleeding event group and the non-bleeding event group for patients with stent-assisted embolization of aneurysms. At the same time, the study of He, D et al. [22] suggested that for patients with ischemic stroke, the relationship between ADPi and MA-ADP and the occurrence of bleeding events was also shown after dual-antibody treatment. Contrary to our study, they considered no statistical difference in AAi between the two groups, whereas our study showed no significant difference in ADPi between the bleeding and non-bleeding groups. At the same time, Xu, R et al. [23]showed that R and MA-ADP were risk factors for bleeding events in patients with stent-assisted aneurysm embolization, and R and MA-ADP could be used as predictors of bleeding events. The study of Liang et al. [24] showed that for patients with acute ischemic stroke, the R-value can be used to assess bleeding events in such patients. Although studies have shown[25]that dual antiplatelet therapy can affect R and α angles, our study did not show that R values and α angles had a predictive effect on bleeding events in patients. Meanwhile, the study by He, Q et al. [26] showed that AAi and ADPi were independent risk factors for rebleeding in patients with aneurysmal subarachnoid hemorrhage, which was similar to our findings. In addition, other studies have demonstrated that TEG can predict bleeding tendencies [27, 28].
Various previous studies have shown that thromboelastometry parameters may be associated with bleeding events in a variety of patients, but our study is only for patients with ruptured aneurysms. Because most patients with intracranial aneurysms in our center have ruptured aneurysms due to clinical symptoms, we have constructed this diagram only for patients with ruptured aneurysms who have received stent-assisted embolization. Meanwhile, our nomogram has the following innovations. First, to our knowledge, no one has previously designed a nomogram for the patients. The nomograms we created enable individualized screening, and the effective identification of patients with possible bleeding events can provide evidence for appropriate adjustment of their treatment strategies.
Limitation
At the same time, this study has some limitations. Our study is a single-center retrospective study, and small sample size may affect the results. At the same time, we only analyzed patients with ruptured aneurysms, but the conclusions for patients with unruptured aneurysms are unknown. And all patients had only one TEG test, although it is common in clinical work, it may lead to the insufficient observation of the dynamic changes of related parameters. Finally, the subjects we included are all Chinese patients. Due to the existence of genetic problems, the promotion of the results may need further research.