Machine learning derived model for the prediction of bleeding in dual antiplatelet therapy patients

Objective This study aimed to develop a predictive model for assessing bleeding risk in dual antiplatelet therapy (DAPT) patients.Methods A total of 18,408 DAPT patients were included. Data on patients' demographics, clinical features, underlying diseases, past history, and laboratory examinations were collected from Affiliated Dongyang Hospital of Wenzhou Medical University. The patients were randomly divided into two groups in a proportion of 7:3, with the most used for model development and the remaining for internal validation. LASSO regression, multivariate logistic regression, and six machine learning models, including random forest (RF), k-nearest neighbor imputing (KNN), decision tree (DT), extreme gradient boosting (XGBoost), light gradient boosting machine (LGBM), and Support Vector Machine (SVM), were used to develop prediction models. Model prediction performance was evaluated using area under the curve (AUC), calibration curves, decision curve analysis (DCA), clinical impact curve (CIC), and net reduction curve (NRC).Results The XGBoost model demonstrated the highest AUC. The model features were comprised of seven clinical variables, including: HGB, PLT, previous bleeding, cerebral infarction, sex, Surgical history, and hypertension. A nomogram was developed based on seven variables. The AUC of the model was 0.861 (95% CI 0.847-0.875) in the development cohort and 0.877 (95% CI 0.856-0.898) in the validation cohort, indicating that the model had good differential performance. The results of calibration curve analysis showed that the calibration curve of this nomogram model was close to the ideal curve. The clinical decision curve also showed good clinical net benefit of the nomogram model.Conclusions This study successfully developed a predictive model for estimating bleeding risk in DAPT patients. It has the potential to optimize treatment planning, improve patient outcomes, and enhance resource utilization.