RISK-FACTORS FAR INTRACRANIAL HEMORRHAGE IN OUTPATIENTS TAKING WARFARIN
RISK-FACTORS FAR INTRACRANIAL HEMORRHAGE IN OUTPATIENTS TAKING WARFARIN
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DOI：
10.7326/0003-4819-120-11-199406010-00001
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发表时间：
1994-06-01
影响因子：
39.2
通讯作者：
SINGER, DE
中科院分区：
文献类型：
--
作者：
HYLEK, EM;SINGER, DE
目的：探讨抗凝药物的合理使用，尤其是老年人，平衡抗血栓疗效和出血风险。既往的前瞻性研究尚未对颅内出血的危险因素提供有力的评估，颅内出血是扭转抗凝治疗决定的主要并发症。设计：病例对照分析。背景：一家大型综合医院及其抗凝治疗单位。患者：121 名连续服用华法林并因颅内出血住院的成人患者，每人与从我院管理的门诊患者中随机选择的 3 名同期对照进行匹配结果：77 名患者出现脑出血（46% 致命），44 名患者出现硬膜下出血（20% 致命）。凝血酶原时间比（PTR）是颅内出血的主要危险因素。在整个范围内，PTR 每增加 0.5，脑出血的风险就会增加一倍（比值比，2.1；95% CI，1.4 至 2.9）。对于硬膜下出血，风险在 1.0 至 2.0 的 PTR 范围内保持不变，但在 PTR 2.0（近似国际标准化比率，4.0）之上急剧上升。年龄是硬膜下出血唯一的其他显着独立危险因素（比值比，每十年 2.0；CI，1.3 至 3.1）。对于脑出血，在控制 PTR 和其他两个独立危险因素后，年龄具有临界意义（比值比，每十年 1.3；CI，1.0 至 1.6）：脑血管疾病史（比值比，3.1；CI，1.7 至 5.6）和存在人工心脏瓣膜（比值比，2.8；CI，1.3 至 5.6） 5.8).结论：结果强调了将凝血酶原时间比维持在 2.0 以下的重要性以及在老年人中特别谨慎使用华法林的必要性。
Objective: To explore the rational use of anticoagulants, especially among the elderly, balancing antithrombotic efficacy and risk for hemorrhage. Previous prospective studies have not provided powerful assessments of risk factors for intracranial hemorrhage, the dominant complication in reversing the anticoagulant decision.Design: Case-control analysis.Setting: A large general hospital and its anticoagulant therapy unit.Patients: 121 consecutive adult patients taking warfarin who were hospitalized with intracranial hemorrhage were each matched to three contemporaneous controls randomly selected from among outpatients managed by our hospital anticoagulant therapy unit.Results: 77 patients had intracerebral hemorrhage (46% fatal) and 44 had subdural hemorrhage (20% fatal). The prothrombin time ratio (PTR) was the dominant risk factor for intracranial hemorrhage. For each 0.5 increase in PTR over the entire range, the risk for intracerebral hemorrhage doubled (odds ratio, 2.1; 95% CI, 1.4 to 2.9). For subdural hemorrhage, the risk was unchanged over the PTR range from 1.0 to 2.0 but rose dramatically above a PTR of 2.0 (approximate international normalized ratio, 4.0). Age was the only other significant independent risk factor for subdural hemorrhage (odds ratio, 2.0 per decade; CI, 1.3 to 3.1). For intracerebral hemorrhage, age was of borderline significance (odds ratio, 1.3 per decade; CI, 1.0 to 1.6) after controlling for PTR and the two other independent risk factors: history of cerebrovascular disease (odds ratio, 3.1; CI, 1.7 to 5.6) and presence of a prosthetic heart valve (odds ratio, 2.8; CI, 1.3 to 5.8).Conclusions: The results emphasize the importance of maintaining the prothrombin time ratios under 2.0 and the need for especially careful use of warfarin in the elderly.