Optimal INR for prevention of stroke and death in atrial fibrillation:: a critical appraisal
Optimal INR for prevention of stroke and death in atrial fibrillation:: a critical appraisal
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DOI：
10.1016/j.thromres.2004.11.025
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发表时间：
2006-01-01
影响因子：
7.5
通讯作者：
Hart, RG
中科院分区：
文献类型：
--
作者：
Odén, A;Fahlén, M;Hart, RG
简介：非瓣膜性心房颤动患者发生全身性栓塞（主要是致残性中风）的风险增加。为了研究中风和死亡率如何随国际标准化比率（INR）反映的不同抗凝程度而变化，我们严格评估来自不同来源的信息。材料和方法：1。使用MEDLINE对1980年至2004年7月期间发表的医学文献进行计算机化检索，适用于心房颤动、华法林、抗凝、抗凝强度和INR等检索词的各种组合，不受语言限制。2．我们对 21,967 名患者进行了记录关联分析，将死亡风险估计为 INR 的连续函数。同样，还估计了因脑血管疾病而入院或死亡的风险。3。对 Hylek 等人之前发布的数据进行重新分析。 2003年起。 结果与结论： 1．一项随机研究表明，与平均 INR 1. 3 联合阿司匹林相比，平均 INR 2.4 的中风风险显着降低。其余研究发现 2-2.5 的 INR 与较高的抗凝强度一样有效。2．死亡率以及因脑血管疾病而入院或死亡的风险呈 U 形曲线，最低分别为 2.2 和 2.4 印度卢比。 INR 高时，INR 每增加 1 个单位，死亡风险增加 2.3 倍，脑血管事件风险增加 1.7 倍。3。 Hylek 等人的数据的重新分析。表明当 INR 从 2.5 增加到 4 时，颅内出血的风险可能会大幅增加。我们得出结论，INR 在 2.0-2.5 区间内，非瓣膜性心房颤动患者中风和死亡的风险最低。 (c) 2005 Elsevier Ltd. 保留所有权利。
Introduction: Patients with nonvalvular atrial fibrillation are at increased risk for systemic embolism, predominantly disabling stroke. To study how stroke and mortality rates vary with different degrees of anticoagulation reflected by the international normalised ratio (INR) we critically assess information from different sources.Materials and methods:1. Computerized search of the medical literature published between 1980 and July 2004 was performed using MEDLINE applied to various combinations of the search terms of atrial fibrillation, warfarin, anticoagulation, anticoagulation intensity, and INR, not restricted by language.2. We performed a record linkage analysis with death hazard estimated as a continuous function of INR based on 21,967 patients. Similarly the risk of admission to hospital or death due to diseases of the vessels of the brain was estimated.3. Re-analysis of data earlier published by Hylek et al. from year 2003.Results and conclusions:1. One randomised study showed a significantly lower risk of stroke for mean INR 2.4 compared to mean INR 1. 3 combined with aspirin. Remaining studies found INRs of 2-2.5 to be as efficacious as higher anticoagulation intensities.2. Mortality as well as risk of admission to hospital or death due to diseases of the vessels of the brain followed U-shaped curves with minimum at INR 2.2 and 2.4, respectively. At high INR the risk increased 2.3 times per 1 unit increase of INR for death and 1.7 times for events in the vessels of the brain.3. The re-analysing of data of Hylek et al. indicated that there might be a substantial increase of the risk of intracranial hemorrhage when INR is increased from 2.5 to 4.We conclude that INRs in the interval 2.0-2.5 give the lowest risk of stroke and death in patients with nonvalvular atrial fibrillation. (c) 2005 Elsevier Ltd. All rights reserved.