A new risk scheme to predict warfarin-associated hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study.
A new risk scheme to predict warfarin-associated hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) Study.
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DOI：
10.1016/j.jacc.2011.03.031
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发表时间：
2011-07-19
影响因子：
24
通讯作者：
Singer, Daniel E.
中科院分区：
文献类型：
--
作者：
Fang, Margaret C.;Go, Alan S.;Chang, Yuchiao;Borowsky, Leila H.;Pomernacki, Niela K.;Udaltsova, Natalia;Singer, Daniel E.
制定一个风险分层评分来预测华法林相关出血。关于华法林治疗房颤的最佳决策需要估计出血风险。我们随访了9,186例房颤患者，华法林随访32,888人-年，从临床数据库中获得数据，并使用病历审查验证出血事件。我们使用考克斯回归模型建立出血风险分层评分，使用自举法选择候选变量。最终模型通过分裂样本测试进行了内部验证，并与6个已发表的出血风险计划进行了比较。我们在随访期间观察到461例首次大出血（每年1.4%）。最终模型中包括五个自变量，并通过回归系数加权：贫血（3分）、严重肾脏疾病（例如，肾小球滤过率< 30 ml/min或依赖透析，3分）、年龄≥ 75岁（2分）、既往出血（1分）和高血压（1分）。大出血发生率范围为每年0.4%（0分）至17.3%（10分）。合并为3类风险评分，低风险组（0-3分）的大出血率为0.8%，中等风险组（4分）为2.6%，高风险组（5-10分）为5.8%。连续风险评分的c指数为0.74，3类评分的c指数为0.69，高于其他风险计划。与所有六个比较国相比，重新分类净改善（从27%增加到56%）。一个简单的5变量风险评分是有效的量化华法林相关出血的风险在一个大型的社区为基础的队列房颤患者。
To develop a risk stratification score to predict warfarin-associated hemorrhage Optimal decision-making regarding warfarin use for atrial fibrillation requires estimation of hemorrhage risk. We followed 9,186 patients with atrial fibrillation contributing 32,888 person-years of follow-up on warfarin, obtaining data from clinical databases and validating hemorrhage events using medical record review. We used Cox regression models to develop a hemorrhage risk stratification score, selecting candidate variables using bootstrapping approaches. The final model was internally validated via split-sample testing and compared to six published hemorrhage risk schemes. We observed 461 first major hemorrhages during follow-up (1.4% annually). Five independent variables were included in the final model and weighted by regression coefficients: anemia (3 points), severe renal disease (e.g., glomerular filtration rate < 30 ml/min or dialysis-dependent, 3 points), age ≥ 75 years (2 points), prior bleeding (1 point), and hypertension (1 point). Major hemorrhage rates ranged from 0.4% (0 points) to 17.3% per year (10 points). Collapsed into a 3-category risk score, major hemorrhage rates were 0.8% in the low risk group (0-3 points), 2.6% in intermediate risk (4 points), and 5.8% in high risk (5-10 points). The c-index for the continuous risk score was 0.74 and 0.69 for the 3-category score, higher than in the other risk schemes. There was net reclassification improvement versus all six comparators (from 27% to 56%). A simple 5-variable risk score was effective in quantifying the risk of warfarin-associated hemorrhage in a large community-based cohort of patients with atrial fibrillation.
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影响因子：
2
作者：
Pencina, Michael J.;D'Agostino, Ralph B., Sr.;Steyerberg, Ewout W.
通讯作者：
Steyerberg, Ewout W.
影响因子：
--
作者：
Kuijer, PMM;Hutten, BA;Büller, HR
通讯作者：
Büller, HR
影响因子：
1.8
作者：
Austin, PC;Tu, JV
通讯作者：
Tu, JV
影响因子：
4.8
作者：
Gage, BF;Yan, Y;Radford, MJ
通讯作者：
Radford, MJ
影响因子：
158.5
作者：
Kearon, C;Ginsberg, JS;Gent, M
通讯作者：
Gent, M