Major bleeding during anticoagulation after cerebral ischemia
Major bleeding during anticoagulation after cerebral ischemia
复制标题
脑缺血后抗凝期间大出血
作者：
J. Gorter
目的：评估 651 名抗凝患者出血的独立预测因素。背景：在接受口服抗凝治疗的推测为动脉源性非致残性脑缺血的患者中，大出血发生率过高（每年 7%），导致可逆性缺血试验 (SPIRIT) 提前终止。方法：通过单变量和多变量分析评估已知危险因素与出血之间的关系。我们将危险因素与欧洲心房颤动试验 (EAFT) 中 225 名因脑缺血伴房颤而接受抗凝治疗的患者进行了比较。结果：脑白质疏松症（风险比 [HR] 2.7，95% 置信区间 [CI] 1.4 至 5.3）和年龄大于 65 岁（HR 1.9，95% CI 1.0 至 3.4）是 SPIRIT 中所有抗凝相关出血的独立预测因素。 SPIRIT 的颅内出血发生率为每年 3.7%；国际标准化比值 (INR) 每上升 0.5 单位，该发病率就会增加 1.37 倍。在校正 SPIRIT 和 EAFT 患者之间的基线差异后，推测动脉起源的脑缺血患者的颅内出血风险比房颤患者高 19 倍（95% CI 2.4 至 150）。结论：除了抗凝强度外，脑白质疏松和年龄大于65岁是因推测动脉源性脑缺血而抗凝患者出血的独立危险因素。与房颤患者相比，这些患者发生抗凝相关颅内出血的固有风险更高。
Objective: To assess independent predictors of hemorrhage in 651 anticoagulated patients. Background: An excess incidence of major bleeding (7% per year) in patients with nondisabling cerebral ischemia of presumed arterial origin treated with oral anticoagulation led to early termination of the Stroke Prevention In Reversible Ischemia Trial (SPIRIT). Methods: The relationship between known risk factors and hemorrhage was assessed by univariate and multivariate analyses. We compared the risk factors with those in 225 patients anticoagulated because of cerebral ischemia with atrial fibrillation in the European Atrial Fibrillation Trial (EAFT). Results: Leukoaraiosis (hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.4 to 5.3) and age older than 65 years (HR 1.9, 95% CI 1.0 to 3.4) were independent predictors of all anticoagulation-related hemorrhages in SPIRIT. The incidence of intracranial bleeding in SPIRIT was 3.7% per year; this incidence increased by a factor of 1.37 for each 0.5 unit international normalized ratio (INR). Patients with cerebral ischemia of presumed arterial origin had a 19 times (95% CI 2.4 to 150) higher risk of intracranial hemorrhages than those with atrial fibrillation after correcting for baseline differences between SPIRIT and EAFT patients. Conclusions: In addition to the intensity of anticoagulation, leukoaraiosis and age older than 65 years are independent risk factors for bleeding in patients anticoagulated because of cerebral ischemia of presumed arterial origin. These patients have a higher inherent risk of anticoagulation-related intracranial hemorrhages than patients with atrial fibrillation.
房颤患者抗血栓治疗期间的出血。
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