Clinical classification schemes for predicting hemorrhage: Results from the National Registry of Atrial Fibrillation (NRAF)
Clinical classification schemes for predicting hemorrhage: Results from the National Registry of Atrial Fibrillation (NRAF)
复制标题
DOI：
10.1016/j.ahj.2005.04.017
复制
发表时间：
2006-03-01
影响因子：
4.8
通讯作者：
Radford, MJ
中科院分区：
文献类型：
--
作者：
Gage, BF;Yan, Y;Radford, MJ
虽然华法林和其他抗凝剂可以预防缺血性事件，但它们可能导致出血。定量出血率对于确定处方抗血栓治疗的风险和净收益至关重要。我们的目的是找到一种出血分类方案，可以量化老年心房颤动患者出血的风险。方法将现有分类方案中的出血危险因素合并为新的方案HEMORR(2)HAGES，并对所有出血分类方案进行验证。我们对HEMORR(2)HAGES进行评分，对既往出血加2分，对其他危险因素加1分：肝脏或肾脏疾病、乙醇滥用、恶性肿瘤、年龄较大（年龄0 ~ 75岁）、血小板计数或功能减少、高血压（未控制）、贫血、遗传因素、过度跌倒风险和中风。我们使用来自代表7个州的质量改进组织的数据来收集3791名房颤医疗保险受益人的注册表。结果162例住院患者采用《国际疾病分类第九版临床修改代码》中的出血分类。每增加1分，每100个战争患者年的出血率为：0分1.9分，1分2.5分，2分5.3分，3分8.4分，4分10.4分，5分12.3分。在使用华法林的患者中，HEMORR(2)HAGES的预测准确率高于其他出血预测方案（c统计值为0.67）（P < 0.001）。结论采用现有的分级方案，特别是新的出血风险分级方案HEMORR(2)HAGES，可以量化出血风险，有助于抗栓治疗的管理。
Background Although warfarin and other anticoagulants can prevent ischemic events, they can cause hemorrhage. Quantifying the rate of hemorrhage is crucial for determining the risks and net benefits of prescribing antithrombotic therapy. Our objective was to find a bleeding classification scheme that could quantify the risk of hemorrhage in elderly patients with atrial fibrillation.Methods We combined bleeding risk factors from existing classification schemes into a new scheme, HEMORR(2)HAGES, and validated all bleeding classification schemes. We scored HEMORR(2)HAGES by adding 2 points for a prior bleed and 1 point for each of the other risk factors: hepatic or renal disease, ethanol abuse, malignancy, older (age > 75 years), reduced platelet count or function, hypertension (uncontrolled), anemia, genetic factors, excessive fall risk, and stroke. We used data from quality improvement organizations representing 7 states to assemble a registry of 3791 Medicare beneficiaries with atrial fibrillation.Results There were 162 hospital admissions with an International Classification of Diseases, Ninth Revision, Clinical Modification code for hemorrhage. With each additional point, the rate of bleeding per 100 patient-years of war forin increased: 1.9 for 0, 2.5 for 1, 5.3 for 2, 8.4 for 3, 10.4 for 4, and 12.3 for : 5 points. In patients prescribed warfarin, HEMORR(2)HAGES had greater predictive accuracy (c statistic 0.67) than other bleed prediction schemes (P < .001).Conclusions Adaptations of existing classification schemes, especially anew bleeding risk scheme, HEMORR(2)HAGES, can quantify the risk of hemorrhage and aid in the management of antithrombotic therapy.