Oral anticoagulation for cerebral ischemia of arterial origin - High initial bleeding risk
Oral anticoagulation for cerebral ischemia of arterial origin - High initial bleeding risk
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DOI：
10.1212/wnl.57.11.1993
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发表时间：
2001-12-11
期刊：
影响因子：
9.9
通讯作者：
Rosendaal, FR
中科院分区：
文献类型：
--
作者：
Torn, M;Algra, A;Rosendaal, FR
工作背景：在缺血性卒中患者中使用口服抗凝剂治疗预防动脉血栓栓塞是有争议的。香豆素类药物可能增加动脉源性脑缺血患者的出血风险。目的：1）计算在抗凝门诊接受常规治疗的非心源性脑缺血患者的出血和血栓栓塞事件发生率。2)评估导致事件发生的因素。3)确定这些患者口服抗凝治疗的最佳强度。方法：作者研究了1993年至1998年在莱顿抗凝门诊接受非心源性脑缺血治疗的所有患者。结局事件为严重出血、严重动脉血栓栓塞和死亡。结果：作者观察了356例患者，共644患者年。大出血的发生率为3.9/100患者-年（95% CI，2.5 - 5.7），血栓栓塞的发生率为3.0/100患者-年（95% CI，1.8 - 4.6）。出血的发生率随治疗时间的长短而变化（第一个半年与第二个半年的相对风险[RR]，3.8; 95% CI，1.9至7.6），年龄（RR> 65岁，3.7; 95% CI，1.1 - 12.3）和口服抗凝剂的强度（国际标准化比值[INR]单位每增加0.5，RR为1.8; 95% CI为1.5 - 2.3）。口服抗凝治疗的最佳强度为2.5 ~ 3.5 INR;最佳目标值为3.0 INR。结论：在动脉源性缺血性卒中患者中，抗凝治疗的出血风险较高，但主要限于早期使用和老年患者。
Background: The use of oral anticoagulant therapy for the prevention of arterial thromboembolism in patients who have had ischemic stroke is controversial. Coumarins may increase the bleeding risk in patients with cerebral ischemia of arterial origin. Objectives: 1) To calculate incidence rates of bleeding and thromboembolic events in patients with noncardiac cerebral ischemia who were treated routinely in an anticoagulation clinic. 2) To assess which factors contribute to the occurrence of events. 3) To determine the optimal intensity of oral anticoagulant therapy in these patients. Methods: The authors studied all patients treated for noncardiac cerebral ischemia at the Leiden anticoagulation clinic between 1993 and 1998. Outcome events were major hemorrhage, major arterial thromboembolism, and death. Results: The authors observed 356 patients for 644 patient-years. The incidence of major hemorrhage was 3.9 per 100 patient-years (95% CI, 2.5 to 5.7) and that of thromboembolism was 3.0 per 100 patient-years (95% CI, 1.8 to 4.6). The incidence of hemorrhage varied with the duration of treatment (relative risk [RR] of the first versus the second half-year, 3.8; 95% CI, 1.9 to 7.6), age (RR for age > 65 years, 3.7; 95% CI, 1.1 to 12.3), and the intensity of oral anticoagulation (RR, 1.8 for each 0.5 international normalized ratio [INR] unit increase; 95% Cl, 1.5 to 2.3). The optimal intensity of oral anticoagulant therapy was 2.5 to 3.5 INR; the best target value was 3.0 INR. Conclusion: The risk of hemorrhage with anticoagulant therapy is high in patients with ischemic stroke of arterial origin but is mainly confined to early use and elderly patients.