Department of Internal Medicine "C,", Rabin Medical Center, Hasharon Hospital, Petah-Tiqva, Israel. bermanm@clalit
J Am Geriatr Soc. 2012 Sep;60(9):1713-7. doi: 10.1111/j.1532-5415.2012.04103.x. Epub 2012 Aug 6.
To assess bleeding complications and outcome of individuals receiving oral anticoagulants who were admitted to the hospital with an international normalized ratio (INR) greater than 4 by comparing them according to age (≤ 80, >80).
Retrospective cohort study.
Community hospital.
All individuals (N = 253) admitted to the Department of Internal Medicine over a period of 4 years with an INR greater than 4: Group I, aged 80 and younger (n = 127); Group II, older than 80 (n = 126). Data included bleeding complications, survival, and quality of INR control before admission and up to 48 months after admission.
Atrial fibrillation was the most common indication for warfarin therapy. Its incidence was higher in the older group (88% vs 73%, P = .004). More elderly participants lived in nursing homes (23% vs 9.4%. P = .004) or received in-home assistance (38.9% vs 20.5%, P = .002). There was no difference in INR upon admission, duration of warfarin treatment, or frequency of INR tests before admission. The incidence of bleeding events was 18.1% in Group I and 12.7% in Group II (P = .30). Major bleeding events occurred in 1.6% of Group I and none of Group II (P = .50). During follow-up after the first admission, the incidence of INR greater than 4 was higher in Group II (87.3% vs 70%, P = .02), without a difference in the number of additional admissions or bleeding events.
Primary care physicians can safely maintain warfarin treatment in elderly adults, even in those with a history of hospitalization for high INR, using frequent INR measurements.
通过比较年龄（≤ 80 岁，>80 岁），评估因国际标准化比值（INR）>4 而住院的接受口服抗凝剂治疗的个体的出血并发症和结局。
回顾性队列研究。
社区医院。
4 年内因 INR>4 而在内科住院的所有个体（N=253）：第 1 组，年龄 80 岁及以下（n=127）；第 2 组，年龄>80 岁（n=126）。数据包括出血并发症、生存情况以及入院前和入院后 48 个月内 INR 控制的质量。
华法林治疗的最常见适应证是心房颤动。高龄组的发生率更高（88%比 73%，P=0.004）。更多的高龄患者居住在养老院（23%比 9.4%，P=0.004）或接受家庭护理（38.9%比 20.5%，P=0.002）。入院时的 INR、华法林治疗持续时间或入院前 INR 检测频率无差异。第 1 组出血事件的发生率为 18.1%，第 2 组为 12.7%（P=0.30）。第 1 组有 1.6%发生大出血事件，第 2 组无（P=0.50）。首次入院后随访期间，第 2 组 INR>4 的发生率更高（87.3%比 70%，P=0.02），但再次入院或出血事件的数量无差异。
初级保健医生可以通过频繁的 INR 测量，安全地为高龄成年人（包括因 INR 升高而住院的成年人）维持华法林治疗。
