Major bleeding after hospitalization for deep-venous thrombosis
Major bleeding after hospitalization for deep-venous thrombosis
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DOI：
10.1016/s0002-9343(99)00267-3
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发表时间：
1999-11-01
影响因子：
5.9
通讯作者：
Romano, PS
中科院分区：
文献类型：
--
作者：
White, RH;Beyth, RJ;Romano, PS
目的：大多数关于口腔抗凝剂相关出血的研究分析了各种不同情况的患者的不良结局的发生率，并且没有与对照组进行任何比较。我们确定了深静脉血栓形成患者出院后大出血的发生率、雾化病程和危险因素，并估计了口服抗凝治疗相关的出血超额风险。方法：1992年1月1日至1994年9月30日期间，共有22,000名被诊断为深静脉血栓形成的成年人在加州住院3天或更长时间。我们确定了与再次入院出血相关的危险因素。我们比较了肺炎或蜂窝织炎患者与年龄、性别、种族和住院时间匹配的对照队列因出血而再次住院的发生率。结果：在21,250名没有出血的深静脉血栓患者中，1.4%的患者在91天内因出血而再次住院；前30天的比率是随后61天的2.7倍。出血的危险因素包括过去18个月内因胃肠道出血住院(相对危险度[RH]=2.6，95%可信区间[CII：1.6至4.1])，过去18个月内因酒精相关诊断住院(RI-I=2.6，95%CI：1.4至4.8)，慢性肾脏疾病(RH=2.4，95%CI：1.4至4.2)，女性(RH=1.7，95%CI：1.3至2.2)，有恶性肿瘤(RH=1.6，95%CI：1.2~2.2)，非白人(RH=1.6，95%CI：1.2~2.1)，65岁以上(RFI=1.3，95%CI：1.0~1.7)。发生颅内出血的女性(n=40)明显多于男性(n=18，P=0.02)。在对照队列中，出院后3个月内因出血再入院的发生率为0.7%，深静脉血栓患者再入院的相对风险(RR)高于蜂窝织炎(RR=2.0，95%CI：1.6~2.5)或肺炎(RR=2.0，95%CI：1.7~2.5)。结论：出院后前30天因出血再住院的发生率最高，约为蜂窝组织炎或肺炎住院患者的两倍。需要进一步的研究来确定为什么女性和非白人患者抗凝剂相关出血的风险增加。我是J·梅德。1999年；107：414-424。(C)1999年，由Excerpta Medica，Inc.
PURPOSE: Most studies of oral anticoagulant-related bleeding have analyzed the incidence of adverse outcomes among patients with a variety of different conditions and without any comparison with a control group. We determined the incidence, rime course, and risk factors associated with major bleeding after hospital discharge among patients with deep-vein thrombosis, and estimated the excess risk of bleeding associated with oral anticoagulant therapy.METHODS: A total of 22,000 adults were hospitalized in California for 3 or more days with a diagnosis of deep-venous thrombosis between January 1, 1992, and September 30, 1994. We determined the risk factors associated with readmission for bleeding. We compared the incidence of readmission for bleeding with comparison cohorts of patients with pneumonia or cellulitis who were matched for age, gender, race, and length of hospital stay.RESULTS: Of 21,250 patients with deep-venous thrombosis who were discharged without bleeding, 1.4% were readmitted for bleeding within 91 days; the rate was 2.7 times greater In the first 30 days than in the next 61 days. Risk factors for bleeding included hospitalization with gastrointestinal bleeding during the previous 18 months (relative hazard [RH] = 2.6, 95% confidence interval [CII: 1.6 to 4.1), hospitalization with an alcohol-related diagnosis during the previous 18 months (RI-I = 2.6, 95% CI: 1.4 to 4.8), chronic renal disease(RH = 2.4, 95% CI: 1.4 to 4.2), female gender (RH = 1.7, 95% CI: 1.3 to 2.2), presence of a malignancy (RH = 1.6, 95% CI: 1.2 to 2.2), nonwhite race (RH = 1.6, 95% CI: 1.2 to 2.1), and age over 65 years (RFI = 1.3, 95% CI: 1.0 to 1.7). Significantly more women (n = 40) had intracranial bleeding than men (n = 18, P = 0.02). In the comparison cohorts, the incidence of readmission for bleeding within 3 months of discharge was 0.7%, and the relative risk (RR) of readmission was greater in those with deep-venous thrombosis than in those with cellulitis (RR = 2.0, 95% CI: 1.6 to 2.5) or pneumonia (RR = 2.0, 95% CI: 1.7 to 2.5).CONCLUSIONS: The incidence of rehospitalization for bleeding was greatest in the first 30 days after discharge, and was approximately twice that seen in patients hospitalized for cellulitis or pneumonia. Further studies are needed to determine why women and nonwhite patients are at increased risk for anticoagulant-related bleeding. Am J Med. 1999;107:414-424. (C) 1999 by Excerpta Medica, Inc.