分析基于Caprini评分动态监测的个体化抗凝管理与肺栓塞(pulmonary embolism, PE)住院患者住院期间临床结局的关联。

回顾性队列研究。分析2022年5月至2024年5月我院收治的179例PE住院患者(入院时Caprini评分≥5分)，按住院期间抗凝管理方式分为Caprini动态监测联合个体化抗凝87例为观察组，常规抗凝管理92例为对照组。比较两组住院期间新发PE及深静脉血栓(deep venous thrombosis, DVT)发生率、凝血功能指标、D-二聚体、动脉血气分析、超声估测肺动脉收缩压、出血事件、全因死亡。采用多因素Logistic回归及逆概率加权(inverse probability of treatment weighting, IPTW)控制混杂。

观察组住院期间新发PE发生3例(3.45%)低于对照组12例(13.04%)(χ²＝4.185，P＝0.041)；观察组新发DVT发生率6.90%、复查CTPA阳性率低于对照组17.39%、14.13%(P<0.05)。治疗后观察组D-二聚体(1.02±0.46)μg/ml、Fbg(2.91±0.69)g/L低于对照组(1.92±0.84)μg/ml、(3.56±0.88)g/L；观察组PaO₂、PaO₂/FiO₂高于对照组，肺动脉收缩压低于对照组(P<0.001)。凝血功能方面，治疗后观察组PT(12.9±1.2)s、APTT(32.5±4.0)s及INR(1.08±0.12)低于对照组(13.4±1.5)s、(36.5±5.9)s、(1.20±0.18)，两组数值均处于或接近正常参考范围(P<0.001)。两组出血事件(4.60%比3.26%，P＝0.715)及住院期间全因病死率(1.15%比5.43%，P>0.05)差异无统计学意义；观察组总有效76例(87.37%)高于对照组75例(81.52%)，P>0.05。多因素Logistic回归及IPTW加权分析结果与主分析方向一致。

本文回顾性研究提示，基于Caprini动态监测的个体化抗凝管理与PE住院患者住院期间较低的血栓相关事件发生率及多维临床指标改善相关，且未增加出血风险，可能具有临床参考价值及意义。受回顾性设计所限，本文发现属关联性而非因果性结论，尚需前瞻性研究进一步验证。

To examine the association between individualized anticoagulation management guided by dynamic Caprini scoring and in-hospital clinical outcomes in patients with pulmonary embolism (PE).

This was a retrospective cohort study. A total of 179 hospitalized patients with PE (Caprini score ≥5 on admission) admitted to our hospital between May 2022 and May 2024 were analyzed, including 102 men and 77 women. According to the anticoagulation management strategy used during hospitalization, patients were divided into an observation group (n=87, dynamic Caprini monitoring combined with individualized anticoagulation) and a control group (n=92, routine anticoagulation management). The study endpoint was restricted to the in-hospital period. The incidence of new-onset PE and deep venous thrombosis (DVT), coagulation indices, D-dimer, arterial blood gas parameters, echocardiographically estimated pulmonary arterial systolic pressure, bleeding events and all-cause mortality were compared between the two groups. Multivariable logistic regression and inverse probability of treatment weighting (IPTW) were used to control for confounding.

Baseline characteristics were comparable between the two groups (all P>0.05). The incidence of new-onset PE was lower in the observation group than in the control group [3.45%(3/87) vs. 13.04% (12/92); χ²=4.185, P=0.041], as were the incidences of new-onset DVT (6.90% vs. 17.39%, P=0.040) and the repeat CTPA positivity rate (3.45% vs. 14.13%, P=0.017). After treatment, D-dimer and fibrinogen were lower, PaO₂ and the oxygenation index were higher, and pulmonary arterial systolic pressure was lower in the observation group (all P<0.001). PT, APTT and INR also differed significantly between groups, with lower values in the observation group that remained within or close to the normal reference range. No significant differences were found in bleeding events (4.60% vs. 3.26%, P=0.715), in-hospital all-cause mortality (1.15% vs. 5.43%, P=0.212) or the overall response rate (87.37% vs. 81.52%, P=0.05). Multivariable logistic regression and IPTW-weighted analyses were consistent in direction with the primary analysis.

This retrospective study suggests that individualized anticoagulation management guided by dynamic Caprini monitoring is associated with a lower incidence of in-hospital thromboembolic events and with improvement in multiple clinical indicators, without an increase in bleeding risk. Given the retrospective design, these findings are associative rather than causal and require confirmation in prospective studies.