Out-of-range INR values and outcomes among new warfarin patients with non-valvular atrial fibrillation.
Out-of-range INR values and outcomes among new warfarin patients with non-valvular atrial fibrillation.
复制标题
非瓣膜房颤的新华法林患者中的远程INR值和结果。
DOI：
10.1007/s11096-014-0038-3
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发表时间：
2015-02
影响因子：
2.4
通讯作者：
Schein, Jeffrey R.
中科院分区：
文献类型：
--
作者：
Nelson, Winnie W.;Wang, Li;Baser, Onur;Damaraju, Chandrasekharrao V.;Schein, Jeffrey R.
背景：虽然华法林对非瓣膜性心房颤动的卒中预防有效，但许多华法林患者的治疗效果并不理想。目的评价新发华法林合并非瓣膜性房颤患者的国际标准化比值控制与临床转归的关系。从2007年10月至2012年9月的美国退伍军人健康管理局数据集中选择开始华法林治疗的成人非瓣膜性心房颤动患者（≥18岁）。方法从华法林起始日期到首次临床结果、华法林暴露结束或死亡的时间，对有效的国际标准化比值值进行分析。每个病人都贡献了多个范围内和范围外的时间段。评估与国际标准化比率控制相关的临床结果的相对危险比。结果34,346例患者纳入分析。华法林暴露期间，急性冠脉综合征国际标准化比值<2:13.66时，每100人年的事件发生率最高；缺血性中风10.30；短暂性脑缺血发作2.93次；全身性栓塞1.81；大出血4.55分。泊松回归证实，在国际标准化比值<2的时间段内，患者发生急性冠状动脉综合征（相对危险比为7.9,95%置信区间为6.9-9.1）、缺血性卒中（相对危险比为7.6,95%置信区间为6.5-8.9）、短暂性脑缺血发作（相对危险比为8.2,95%置信区间为6.1-11.2）、全身性栓塞(相对危险比为6.3；95%可信区间4.4-8.9)和大出血（相对风险比：2.6；95%可信区间2.2-3.0）。在国际标准化比率>.3的时间段内，患者大出血的风险显著增加（相对风险比：1.5；95%可信区间为1.2-2.0）。结论：在退伍军人健康管理局非瓣膜性房颤人群中，暴露于超出范围的国际标准化比率值与不良临床结果的风险显著增加相关。
Background Although efficacious in stroke prevention in non-valvular atrial fibrillation, many warfarin patients are sub-optimally managed. Objective To evaluate the association of international normalized ratio control and clinical outcomes among new warfarin patients with non-valvular atrial fibrillation. Setting Adult non-valvular atrial fibrillation patients (≥18 years) initiating warfarin treatment were selected from the US Veterans Health Administration dataset between 10/2007 and 9/2012. Method Valid international normalized ratio values were examined from the warfarin initiation date through the earlier of the first clinical outcome, end of warfarin exposure or death. Each patient contributed multiple in-range and out-of-range time periods. Main outcome measure The relative risk ratios of clinical outcomes associated with international normalized ratio control were estimated. Results 34,346 patients were included for analysis. During the warfarin exposure period, the incidence of events per 100 person-years was highest when patients had international normalized ratio <2:13.66 for acute coronary syndrome; 10.30 for ischemic stroke; 2.93 for transient ischemic attack; 1.81 for systemic embolism; and 4.55 for major bleeding. Poisson regression confirmed that during periods with international normalized ratio <2, patients were at increased risk of developing acute coronary syndrome (relative risk ratio: 7.9; 95 % confidence interval 6.9–9.1), ischemic stroke (relative risk ratio: 7.6; 95 % confidence interval 6.5–8.9), transient ischemic attack (relative risk ratio: 8.2; 95 % confidence interval 6.1–11.2), systemic embolism (relative risk ratio: 6.3; 95 % confidence interval 4.4–8.9) and major bleeding (relative risk ratio: 2.6; 95 % confidence interval 2.2–3.0). During time periods with international normalized ratio >3, patients had significantly increased risk of major bleeding (relative risk ratio: 1.5; 95 % confidence interval 1.2–2.0). Conclusion In a Veterans Health Administration non-valvular atrial fibrillation population, exposure to out-of-range international normalized ratio values was associated with significantly increased risk of adverse clinical outcomes.
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影响因子：
37.8
作者：
Go AS;Mozaffarian D;Roger VL;Benjamin EJ;Berry JD;Blaha MJ;Dai S;Ford ES;Fox CS;Franco S;Fullerton HJ;Gillespie C;Hailpern SM;Heit JA;Howard VJ;Huffman MD;Judd SE;Kissela BM;Kittner SJ;Lackland DT;Lichtman JH;Lisabeth LD;Mackey RH;Magid DJ;Marcus GM;Marelli A;Matchar DB;McGuire DK;Mohler ER 3rd;Moy CS;Mussolino ME;Neumar RW;Nichol G;Pandey DK;Paynter NP;Reeves MJ;Sorlie PD;Stein J;Towfighi A;Turan TN;Virani SS;Wong ND;Woo D;Turner MB;American Heart Association Statistics Committee and Stroke Statistics Subcommittee
通讯作者：
American Heart Association Statistics Committee and Stroke Statistics Subcommittee
影响因子：
4
作者：
Merli, Geno J.;Tzanis, George
通讯作者：
Tzanis, George
影响因子：
8.3
作者：
WOLF, PA;ABBOTT, RD;KANNEL, WB
通讯作者：
KANNEL, WB
影响因子：
--
作者：
Tapson, VF;Hyers, TM;Shillington, AC
通讯作者：
Shillington, AC
影响因子：
3.1
作者：
Mearns, Elizabeth S.;White, C. Michael;Coleman, Craig I.
通讯作者：
Coleman, Craig I.