How Well Do Stroke Risk Scores Predict Hemorrhage in Patients With Atrial Fibrillation?
How Well Do Stroke Risk Scores Predict Hemorrhage in Patients With Atrial Fibrillation?
复制标题
中风风险评分对心房颤动患者出血的预测效果如何？
DOI：
10.1016/j.amjcard.2016.06.014
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Fang,MargaretC
中科院分区：
文献类型：
--
作者：
Quinn,GeneR;Singer,DanielE;Chang,Yuchiao;Go,AlanS;Borowsky,LeilaH;Fang,MargaretC
使用抗凝剂治疗房颤的决定取决于比较患者的中风估计风险与出血风险。卒中风险计划中的几个风险因素与出血风险重叠。我们比较了两种卒中风险评分（CHADS 2和CHA 2DS 2-VASc）和两种出血风险评分（ATRIA出血评分和HAS-BLED评分）对13，559例社区居住的房颤成人患者使用和不使用华法林时大出血的预测效果。在累积的64，741人-年随访中，我们共发现777例大出血事件。ATRIA出血评分对华法林患者的预测能力最高（c指数为0.74 [0.72至0.76]，CHADS 2为0.65 [0.62至0.67]，CHA 2DS 2-VASc为0.65 [0.62至0.67]，HAS-BLED为0.64 [0.61 - 0.66]），在停用华法林的患者中（0.77 [0.74至0.79]，CHADS 2为0.67 [0.64至0.71]，CHA 2DS 2-VASc为0.67 [0.64至0.70]，HAS-BLED为0.68 [0.65至0.71]）。总之，尽管CHADS 2和CHA 2DS 2-VASc卒中评分在预测出血方面优于单独的偶然性，但它们劣于ATRIA出血评分。我们的研究支持使用专门的出血风险分层工具来预测房颤的大出血。
The decision to use anticoagulants for atrial fibrillation depends on comparing a patient's estimated risk of stroke to their bleeding risk. Several of the risk factors in the stroke risk schemes overlap with hemorrhage risk. We compared how well 2 stroke risk scores (CHADS2and CHA2DS2-VASc) and 2 hemorrhage risk scores (the ATRIA bleeding score and the HAS-BLED score) predicted major hemorrhage on and off warfarin in a cohort of 13,559 community-dwelling adults with AF. Over a cumulative 64,741 person-years of follow-up, we identified a total of 777 incident major hemorrhage events. The ATRIA bleeding score had the highest predictive ability of all the scores in patients on warfarin (c-index of 0.74 [0.72 to 0.76] compared with 0.65 [0.62 to 0.67] for CHADS2, 0.65 [0.62 to 0.67] for CHA2DS2-VASc, and 0.64 [0.61 to 0.66] for HAS-BLED) and in those off warfarin (0.77 [0.74 to 0.79] compared with 0.67 [0.64 to 0.71] for CHADS2, 0.67 [0.64 to 0.70] for CHA2DS2-VASc, and 0.68 [0.65 to 0.71] for HAS-BLED). In conclusion, although CHADS2and CHA2DS2-VASc stroke scores were better at predicting hemorrhage than chance alone, they were inferior to the ATRIA bleeding score. Our study supports the use of dedicated hemorrhage risk stratification tools to predict major hemorrhage in atrial fibrillation.
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DOI：
10.1056/nejm199011293232201
发表时间：
1990-11
期刊：
The New England journal of medicine
影响因子：
--
作者：
D. Singer;R. Hughes;D. Gress;Mary A. Sheehan;L. Oertel;S. W. Maraventano;D. Blewett;B. Rosner;J. Kistler
通讯作者：
D. Singer;R. Hughes;D. Gress;Mary A. Sheehan;L. Oertel;S. W. Maraventano;D. Blewett;B. Rosner;J. Kistler
影响因子：
8.9
作者：
Chen, Wendy T.;White, C. Michael;Coleman, Craig I.
通讯作者：
Coleman, Craig I.
影响因子：
24
作者：
Fang, Margaret C.;Go, Alan S.;Chang, Yuchiao;Borowsky, Leila H.;Pomernacki, Niela K.;Udaltsova, Natalia;Singer, Daniel E.
通讯作者：
Singer, Daniel E.
DOI：
10.1016/j.accreview.2004.02.060
发表时间：
2003-11
期刊：
JAMA
影响因子：
--
作者：
A. Go;E. Hylek;Yuchiao Chang;Katherine Phillips;Lori Henault;A. Capra;Nancy G. Jensvold;J. Selby;D. Singer
通讯作者：
A. Go;E. Hylek;Yuchiao Chang;Katherine Phillips;Lori Henault;A. Capra;Nancy G. Jensvold;J. Selby;D. Singer
影响因子：
9.6
作者：
Lip, Gregory Y. H.;Nieuwlaat, Robby;Crijns, Harry J. G. M.
通讯作者：
Crijns, Harry J. G. M.