Kaiser Permanente Colorado, Aurora, CO; University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Denver, CO.
Kaiser Permanente Colorado, Aurora, CO; University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Denver, CO.
Thromb Res. 2013;132(6):770-5. doi: 10.1016/j.thromres.2013.10.024. Epub 2013 Oct 17.
Avoiding intracranial hemorrhage (ICH) during warfarin therapy is critical but little is known about factors that affect warfarin-related ICH outcomes. We aimed to define the impact of warfarin on ICH incidence rates and to identify baseline clinical characteristics of patients who experienced ICH and factors associated with fatal ICH.
The primary outcome of this retrospective cohort study was the incident ICH rate per 10,000 person-years for patients receiving and not receiving warfarin therapy. Cox proportional hazards modeling was used to adjust for potential confounding factors in assessment of the association of warfarin with fatal ICH.
A total of 1348 patients with incident ICH, 259 (19%) who were receiving warfarin therapy, were included. The incident ICH rates were 74/10,000 (warfarin) and 5/10,000 (non-warfarin) person-years (p<0.001). Warfarin patients were older and carried a higher burden of chronic disease. The unadjusted hazard ratio (HR) for fatal ICH was 1.64 (95% confidence interval [CI] 1.31-2.05) for warfarin patients compared to non-warfarin patients. However, the HR was no longer significant after adjustment for confounding variables (1.10; 95% CI 0.84-1.42). An INR greater than 3.5 at presentation doubled the adjusted risk for fatal ICH with warfarin therapy. Subarachnoid and subdural ICHs were less likely to be fatal than other ICH types, and each year increase in age was associated with 4% increased risk of fatal ICH.
Although warfarin use increases the rate of incident ICH, other factors impact the risk of fatal ICH, even among anticoagulated patients.
在华法林治疗期间避免颅内出血（ICH）至关重要，但对于影响华法林相关 ICH 结局的因素知之甚少。我们旨在确定华法林对 ICH 发病率的影响，并确定发生 ICH 的患者的基线临床特征和与致命性 ICH 相关的因素。
本回顾性队列研究的主要结果是接受和未接受华法林治疗的患者每 10000 人年发生 ICH 的发生率。使用 Cox 比例风险模型调整潜在混杂因素，以评估华法林与致命性 ICH 的相关性。
共纳入 1348 例发生 ICH 的患者，其中 259 例（19%）正在接受华法林治疗。ICH 的发生率分别为 74/10000（华法林）和 5/10000（非华法林）人年（p<0.001）。华法林患者年龄较大，慢性病负担较重。与非华法林患者相比，未调整的致命性 ICH 风险的华法林患者的危险比（HR）为 1.64（95%置信区间 [CI] 1.31-2.05）。然而，在调整混杂变量后，HR 不再显著（1.10；95%CI 0.84-1.42）。就诊时 INR 大于 3.5 使致命性 ICH 的调整风险增加一倍。与其他 ICH 类型相比，蛛网膜下腔和硬膜下 ICH 不太可能致命，年龄每增加 1 年，致命性 ICH 的风险增加 4%。
尽管华法林的使用增加了 ICH 的发生率，但其他因素也会影响致命性 ICH 的风险，即使在抗凝治疗的患者中也是如此。
