Vaccines and changes in coagulation parameters in adults on chronic warfarin therapy: a cohort study
Vaccines and changes in coagulation parameters in adults on chronic warfarin therapy: a cohort study
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DOI：
10.1002/pds.1386
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发表时间：
2007-07-01
影响因子：
2.6
通讯作者：
Jackson, Lisa A.
中科院分区：
文献类型：
--
作者：
Jackson, Michael L.;Nelson, Jennifer C.;Jackson, Lisa A.
目的 华法林通常用于接受流感、肺炎球菌、破伤风和白喉类毒素疫苗的患者，接受华法林治疗的患者也可能接种甲型肝炎疫苗。人们担心疫苗接种可能会改变接受华法林治疗的患者的凝血参数。我们试图确定疫苗接种是否与长期接受华法林治疗的人的国际标准化比值 (INR) 的变化相关。 方法 我们对华盛顿州西部健康维护组织 (HMO) Group Health 的 5167 名成员进行了一项回顾性队列研究，这些成员年龄在 18 岁及以上，并且在 1992 年 1 月 1 日至 2003 年 12 月 31 日期间接受稳定的长期华法林治疗。我们对平均 INR 进行了个人内部比较接种流感、肺炎球菌、破伤风或甲型肝炎疫苗后 28 天内的值与其他时间的平均 INR 值相比。结果 接受流感疫苗与 INR 值的变化无关（平均变化为 0.01；95% 置信区间 (CI) -0.01 至 0.03）；肺炎球菌疫苗（平均变化 0.01；95%CI -0.07 至 0.09）、破伤风疫苗（平均变化 0.03；95%CI -0.03 至 0.10）和甲型肝炎疫苗（平均变化 0.03；95%CI -0.10 至 0.14）也观察到类似的结果。长期接受华法林治疗的成人凝血指标的变化。版权所有 (c) 2007 John Wiley & Sons, Ltd.
Purpose Warfarin is commonly used among patients who receive influenza, pneumococcal, and tetanus and diphtheria toxoid vaccines, and persons on warfarin therapy may also receive Hepatitis A vaccine. There has been concern that vaccinations could potentially alter coagulation parameters in patients on warfarin therapy. We sought to determine whether vaccinations are associated with changes in International Normalized Ratio (INR) in persons on long-term warfarin therapy.Methods We conducted a retrospective cohort study of 5167 members of Group Health, a health maintenance organization (HMO) in western Washington State, who were aged 18 years and older and who were on stable long-term warfarin therapy between 1 January 1992 and 31 December 2003. We made within-person comparisons between mean INR values in the 28 days after receipt of influenza, pneumococcal, tetanus, or hepatitis A vaccine versus mean INR values during other times.Results Receipt of influenza vaccine was not associated with a change in INR value (mean change, 0.01; 95% confidence interval (CI) -0.01 to 0.03); similar results were observed for pneumococcal (mean change 0.01; 95%CI -0.07 to 0.09), tetanus (mean change 0.03; 95%CI -0.03 to 0.10), and hepatitis A vaccines (mean change 0.03; 95%CI -0.10 to 0.14).Conclusions Our results do not suggest that vaccinations lead to clinically significant alterations in coagulation measures among adults on chronic warfarin therapy. Copyright (c) 2007 John Wiley & Sons, Ltd.