Oral anticoagulation and risk of death:: a medical record linkage study
Oral anticoagulation and risk of death:: a medical record linkage study
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DOI：
10.1136/bmj.325.7372.1073
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发表时间：
2002-11-09
影响因子：
105.7
通讯作者：
Fahlén, M
中科院分区：
文献类型：
--
作者：
Odén, A;Fahlén, M
目的研究国际标准化比值（INR）反映的不同抗凝程度对死亡率的影响。设计记录连锁分析，以INR作为死亡风险的连续函数。数据来源于瑞典46家抗凝诊所的计算机病历。受试者记录42 451例患者，3533例死亡，结果全因死亡率与INR水平密切相关，全因死亡率与INR水平呈负相关，全因死亡率与INR水平呈负相关。所有患者的最低死亡风险为2.2 INR，机械心脏瓣膜患者的最低死亡风险为2.3 INR。高INR与高死亡率相关：INR增加1个单位超过2.5，脑出血（149例死亡）和任何原因导致的死亡风险约增加一倍。在INR大于或等于3.0的患者中，1069例死亡发生在7周内;如果风险与INR为2.9的风险一致，则预期死亡人数为569人。因此，至少有500例死亡与高INR值，但不一定引起的treatment.Conclusions与高INR值相关的过度死亡率支持使用不太密集的治疗和一个小的治疗窗口，与INR接近2.2-2.3，无论抗凝治疗的适应症。应采取更多的预防措施，以避免高INR的发作。
Objective To study how mortality varies with different degrees of anticoagulation reflected by the international normalised ratio (INR).Design Record linkage analysis with death hazard estimated as a continuous function of INR.Data sources 46 anticoagulation clinics in Sweden with computerised medical records.Subjects Records for 42 451 patients, 3533 deaths, and 1.25 million INR measurements.Main outcome measures Mortality from all causes and from intracranial haemorrhage.Results Mortality from all causes of death was strongly related to level of INR. Minimum risk of death was attained at 2.2 INR for all patients and 2.3 INR for patients with mechanical heart valve prostheses. A high INR was associated with an excess mortality: with an increase of I unit of INR above 2.5, the risks of death from cerebral bleeding (149 deaths) and from any cause were about doubled. Among patients with an INR of greater than or equal to3.0, 1069 deaths occurred within 7 weeks; if the risk coincided with that with an INR of 2.9, the expected number of deaths would have been 569. Thus at least 500 deaths were associated with a high INR value, but not necessarily caused by the treatment.Conclusions The excess mortality associated with high INR values supports the use of less intensive treatment and a small therapeutic window, with INR close to 2.2-2.3 irrespective of the indication for anticoagulant treatment. More preventive actions should be taken to avoid episodes of high INR.