Optimal Timing of Resumption of Warfarin After Intracranial Hemorrhage
Optimal Timing of Resumption of Warfarin After Intracranial Hemorrhage
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DOI：
10.1161/strokeaha.110.593087
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发表时间：
2010-12-01
期刊：
影响因子：
8.3
通讯作者：
Schulman, Sam
中科院分区：
文献类型：
--
作者：
Majeed, Ammar;Kim, Yang-Ki;Schulman, Sam
背景和目的：华法林相关性颅内出血后需要继续抗凝治疗的患者，恢复抗凝治疗的最佳时机尚不确定。我们进行了一个大型的回顾性队列研究，以获得更精确的risk estimations. Methods，我们回顾了图表的2869例连续客观证实颅内出血超过6年，在3个三级中心。我们计算了恢复和不恢复华法林的每日颅内出血或缺血性卒中的风险;我们重点关注存活第一周且有抗凝或既往卒中的心脏适应症的患者。使用考克斯模型，我们估计了与恢复抗凝治疗的不同时间点相关的这2种不良事件的发生率。计算华法林恢复时间范围内新发颅内出血或缺血性卒中的综合风险。结果：我们在234例患者中发现华法林相关颅内出血（8.2%），其中177例患者（76%）在第一周存活，并提供了随访信息;中位随访时间为69周（四分位距[IQR] 19-144）。59例患者在中位5.6周（IQR 2.6-17）后恢复华法林治疗。重新开始华法林治疗后复发性颅内出血的风险比为5.6（95% CI，1.8-17.2），缺血性卒中的风险比为0.11（95% CI，0.014-0.89）。复发性颅内出血或缺血性卒中的综合风险达到最低点，如果华法林恢复后约10至30 weeks. Conclusion，恢复华法林治疗的最佳时机似乎是在华法林相关的颅内出血后10至30周。（中风。2010;41：2860-2866）。
Background and Purpose-The optimum timing of resumption of anticoagulation after warfarin-related intracranial hemorrhage in patients with indication for continued anticoagulation is uncertain. We performed a large retrospective cohort study to obtain more precise risk estimates.Methods-We reviewed charts of 2869 consecutive patients with objectively verified intracranial hemorrhage over 6 years at 3 tertiary centers. We calculated the daily risk of intracranial hemorrhage or ischemic stroke with and without resumption of warfarin; we focused on patients who survived the first week and had cardiac indication for anticoagulation or previous stroke. Using a Cox model, we estimated rates for these 2 adverse events in relation to different time points of resumed anticoagulation. The combined risk of either a new intracranial hemorrhage or an ischemic stroke was calculated for a range of warfarin resumption times.Results-We identified warfarin-associated intracranial hemorrhage in 234 patients (8.2%), of whom 177 patients (76%) survived the first week and had follow-up information available; the median follow-up time was 69 weeks (interquartile range [IQR] 19-144). Fifty-nine patients resumed warfarin after a median of 5.6 weeks (IQR 2.6-17). The hazard ratio for recurrent intracranial hemorrhage with resumption of warfarin was 5.6 (95% CI, 1.8-17.2), and for ischemic stroke it was 0.11 (95% CI, 0.014-0.89). The combined risk of recurrent intracranial hemorrhage or ischemic stroke reached a nadir if warfarin was resumed after approximately 10 to 30 weeks.Conclusion-The optimal timing for resumption of warfarin therapy appears to be between 10 and 30 weeks after warfarin-related intracranial hemorrhage. (Stroke. 2010;41:2860-2866.)