Intracranial hemorrhage associated with thrombolytic therapy for elderly patients with acute myocardial infarction - Results from the cooperative cardiovascular project
Intracranial hemorrhage associated with thrombolytic therapy for elderly patients with acute myocardial infarction - Results from the cooperative cardiovascular project
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DOI：
10.1161/01.str.31.8.1802
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发表时间：
2000-08-01
期刊：
影响因子：
8.3
通讯作者：
Krumholz, HM
中科院分区：
文献类型：
--
作者：
Brass, LM;Lichtman, JH;Krumholz, HM
背景和目的——颅内出血是急性心肌梗死溶栓治疗的严重并发症，尤其是老年人，但有关风险评估的信息很少。更好地估计个体患者的风险可能允许在风险最高的患者中暂停或使用替代疗法。方法-为了量化风险并确定与溶栓治疗相关的颅内出血的预测因素，我们使用医学图表中的数据进行了一项回顾性队列研究。这项研究涉及美国几乎所有的急症护理医院。 1994 年至 1995 年 9 个月期间，所有出院时主要诊断为急性心肌梗塞的 Medicare 患者均被纳入其中。主要结局指标是接受溶栓治疗的患者中的颅内出血。结果-颅内出血发生率为 1.43%（31 732 例中的 455 例）。在 Logistic 模型中，年龄大于或等于 75 岁、女性、黑人种族、既往中风、血压大于或等于 160 mm Hg、组织纤溶酶原激活剂（与其他溶栓剂相比）、过度抗凝（国际标准化比率大于或等于 4 或凝血酶原时间大于或等于 24），并且低于中位体重（女性小于或等于 65 kg；小于或等于 80 kg）对于男性）是独立的预测因子。根据这些因素制定了危险分层量表：没有或有1个因素（n=6651），颅内出血发生率为0.69%；有 2 个因素（n=10 509），1.02%；有 3 个因素 (n=9074)，1.63%；有 4 个因素 (n=4298)，3.49%；大于或等于 5 个因素 (n=1071)，4.11% (Mantel-Haenszel；P
Background and Purpose-Intracranial hemorrhage is a serious complication of thrombolytic therapy for acute myocardial infarction, especially among the elderly, but little information exists on estimating risk. Better estimation of risk in individual patients may allow for withholding or using alternate therapies among those at highest risk.Methods-To quantify the risk and identify predictors of intracranial hemorrhage associated with thrombolytic therapy, we performed a retrospective cohort study using data from medical charts. The study involved nearly all acute-care hospitals in the United States. All Medicare patients discharged with a principal diagnosis of acute myocardial infarction during a 9-month period in 1994 to 1995 were included. The main outcome measure was intracranial hemorrhage among those treated with thrombolytic therapy.Results-The rate of intracranial hemorrhage was 1.43% (455 of 31 732). In a logistic model, age greater than or equal to 75 years, female, black race, prior stroke, blood pressure greater than or equal to 160 mm Hg, tissue plasminogen activator (versus other thrombolytic agent), excessive anticoagulation (international normalized ratio greater than or equal to 4 or prothrombin time greater than or equal to 24), and below median weight (less than or equal to 65 kg for women; less than or equal to 80 kg for men) were independent predictors. A risk stratification scale was developed on the basis of these factors: with none or 1 of the factors (n=6651), the rate of intracranial hemorrhage was 0.69%; with 2 factors (n=10 509), 1.02%; with 3 factors (n=9074), 1.63%; with 4 factors (n=4298), 3.49%; and with greater than or equal to 5 factors (n=1071), 4.11% (Mantel-Haenszel; P