Prospective evaluation of an index for predicting the risk of major bleeding in outpatients treated with warfarin
Prospective evaluation of an index for predicting the risk of major bleeding in outpatients treated with warfarin
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DOI：
10.1016/s0002-9343(98)00198-3
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发表时间：
1998-08-01
影响因子：
5.9
通讯作者：
Landefeld, CS
中科院分区：
文献类型：
--
作者：
Beyth, RJ;Quinn, LM;Landefeld, CS
目得：评价门诊出血风险指数用于估计华法林治疗门诊患者主要繁殖概率的准确性和临床实用性。该指数是以前从一个不同的医院（推导队列）的556例患者的回顾性队列推导而来的。对象和方法：我们招募了264例开始华法林（验证队列），以验证该指数的前瞻性。所有患者出院后确定，并获得出院前在validationcohol.RESULTS：820例门诊患者（6.5%/年）发生大出血的概率的医生估计。该指数包括大出血的四个独立危险因素：年龄65岁或以上;胃肠道出血史;卒中史;以及四种特定共病中的一种或多种。在验证队列中，该指数预测大出血：48个月时80例低风险患者的累积发生率为3%，166例中风险患者为12%，18例高风险患者为53%（c指数，0.78）。该指数的表现优于医生，后者估计大出血的概率并不比偶然预期的好。在高危患者发生的18起大出血事件中，有17起是可以预防的。结论：门诊出血风险指数根据大出血风险对患者进行了前瞻性分类，并且表现优于医生。在许多高危患者中，通过避免过度抗凝和非甾体类抗炎药，大出血是可以预防的。(C)1998年，Excerpta Medica，Inc.
PURPOSE: To evaluate the accuracy and clinical utility of the Outpatient Bleeding Risk Index for estimating the probability of major breeding in outpatients treated with warfarin. The index was previously derived in a retrospective cohort of 556 patients from a different hospital (derivation cohort).SUBJECTS AND METHODS: We enrolled 264 outpatients starting warfarin (validation cohort) to validate the index prospectively. All patients were identified upon hospital discharge, and physician estimates of the probability of major bleeding were obtained before discharge in the validation cohort.RESULTS: Major bleeding occurred in 87 of 820 outpatients (6.5%/yr). The index included four independent risk factors for major bleeding: age 65 years or greater; history of gastrointestinal bleeding; history of stroke; and one or more of four specific comorbid conditions. In the validation cohort, the index predicted major bleeding: the cumulative incidence at 48 months was 3% in 80 low-risk patients, 12% in 166 intermediate-risk patients, and 53% in 18 high-risk patients (c index, 0.78). The index performed better than physicians, who estimated the probability of major bleeding no better than expected by chance. Of the 18 episodes of major bleeding that occurred in high-risk patients, 17 were potentially preventable.CONCLUSIONS: The Outpatient Bleeding Risk Index prospectively classified patients according to risk of major breeding and performed better than physicians. Major bleeding may be preventable in many high-risk patients by avoidance of over-anticoagulation and nonsteroidal anti-inflammatory agents. (C) 1998 by Excerpta Medica, Inc.