Development and Validation of Dynamic Prediction Model for Thromboembolic and Bleeding Risk in Patients With Atrial Fibrillation Initiating Direct Oral Anticoagulants

Figures

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  Figure 1. Discrimination performance of developed dynamic prediction models in temporal validation cohort. DOAC indicates direct oral anticoagulant.

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  Figure 2. Cumulative incidence for each outcome by risk category in the temporal validation cohort. A, Cumulative incidence plot for ischemic stroke or systemic embolism by risk category. B, Cumulative incidence plot for major bleeding by risk category.

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  Figure 3. Nomograms of dynamic prediction for thromboembolic events and major bleeding events. A, Nomogram for ischemic stroke or systemic embolism risk prediction. B, Nomogram for major bleeding risk prediction. *Bleed risk drugs include NSAID, corticosteroids, and antiplatelets. DOAC indicates direct oral anticoagulant; ED, emergency department; GI gastrointestinal; PCI, percutaneous coronary intervention; PPIs, proton pump inhibitors; SE, systemic embolism; SRIs, serotonin reuptake inhibitors; TIA, transient ischemic attack.

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  Figure 4. Dynamic risk changes of example patient. A, Dynamic risk changes for each outcome in example patient. B, Characteristics of example patient at each landmark. A, Illustrates the patient’s time‐varying risks of ischemic stroke/systemic embolism and major bleeding and evaluates two hypothetical interventions: Intervention 1 involved discontinuing NSAIDs and initiating PPI therapy, while intervention 2 involved discontinuing DOAC therapy. In (B), predictors that changed during the follow‐up period and affected the predicted risk are shown. Additional baseline characteristics that influenced the prediction included age 75 years, male sex, history of ischemic stroke, gastrointestinal bleeding, liver disease, diabetes, and treatment with apixaban and β blockers. *A value of 1 indicates gastrointestinal bleeding without hospitalization, while a value of 2 indicates gastrointestinal bleeding requiring hospitalization. †Bleed risk drugs include NSAIDs, corticosteroids, and antiplatelets. ‡A value of 1 indicates nonemergency hospitalization, while a value of 2 indicates hospitalization via emergency department. DOAC indicates direct oral anticoagulant; GI, gastrointestinal; PPIs, proton…