Racial/ethnic differences in the risk of intracranial hemorrhage among patients with atrial fibrillation
Racial/ethnic differences in the risk of intracranial hemorrhage among patients with atrial fibrillation
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DOI：
10.1016/j.jacc.2007.01.098
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发表时间：
2007-07-24
影响因子：
24
通讯作者：
Chen, Wansu
中科院分区：
文献类型：
--
作者：
Shen, Albert Yuh-Jer;Yao, Janis F.;Chen, Wansu
目的本研究旨在研究心房颤动（AF）患者颅内出血（ICH）风险的种族/民族差异以及华法林对颅内出血风险的影响。背景在一般人群中，非白人患脑出血的风险高于白人。这是否适用于房颤患者以及华法林治疗是否与非白人脑出血风险相关尚不清楚。方法回顾性研究了一组非风湿性房颤住院的多民族无卒中队列患者。通过检索药房和实验室记录评估华法林的使用和抗凝强度。用泊松回归计算粗ICH事件发生率。构建Cox比例风险模型，在调整年龄、性别、高血压、糖尿病、心力衰竭和华法林暴露后，评估种族/民族对脑出血的独立影响。在1995年至2000年期间，我们确定了18867例符合条件的房事住院（78.5%白人，8%黑人，9.5%西班牙裔和3.9%亚洲人）和173例符合条件的ICH事件，随访时间为3.3年。达到的抗凝强度在黑人中较低，但在其他组之间没有差异。华法林在所有种族中都与脑出血风险增加有关，但在非白人中风险的幅度更大。没有性别差异。亚裔以白人为参照的脑出血风险比为4.06(95%可信区间[CI] 2.47 - 6.65)，西班牙裔为2.06 (95% CI 1.31 - 3.24)，黑人为2.04 （95% CI 1.25 - 3.35）。结论：非白人AF患者发生华法林相关脑出血的风险更高。黑人、西班牙裔和亚洲人患脑出血的风险依次高于白人。[J]中华医学会心脏科杂志，2007;50:30 0 -15)(c) 2007。
Objectives This study was designed to study racial/ethnic differences in the risk for intracranial hemorrhage (ICH) and the effect of warfarin on ICH risk among patients with atrial fibrillation (AF).Background Nonwhites are at greater risk for ICH than whites in the general population. Whether this applies to patients with AF and whether warfarin therapy is associated with comparable risk of ICH in nonwhites are unknown.Methods We retrospectively identified a multiethnic stroke-free cohort hospitalized with nonrheumatic AF. Warfarin use and anticoagulation intensity were assessed by searching pharmacy and laboratory records. Crude ICH event rates were calculated by Poisson regression. Cox proportional hazard models were constructed to assess the independent effect of race/ethnicity on ICH after adjusting for age, gender, hypertension, diabetes, heart failure, and warfarin exposure.Results Between 1995 and 2000, we identified 18,867 qualifying AF hospitalizations (78.5% white, 8% black, 9.5% Hispanic, and 3.9% Asian) and 173 qualifying ICH events over 3.3 years follow-up. Achieved anticoagulation intensity was lower among blacks but not different between the other groups. Warfarin was associated with increased ICH risk in all races, but the magnitude of risk was greater among nonwhites. There were no gender differences. The hazard ratio for ICH with whites as referent was 4.06 for Asians (95% confidence interval [CI] 2.47 to 6.65), 2.06 for Hispanics (95% CI 1.31 to 3.24), and 2.04 (95% CI 1.25 to 3.35) for blacks.Conclusions Nonwhites with AF were at greater risk for warfarin-related ICH. Blacks, Hispanics, and Asians were at successively greater ICH risk than whites. (J Am Coll Cardiol 2007;50:309-15) (c) 2007 by the American College of Cardiology Foundation.