Department of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
J Thromb Haemost. 2015 Feb;13(2):197-205. doi: 10.1111/jth.12793. Epub 2014 Dec 30.
Although the possibility of bleeding during anticoagulant treatment may limit patients from taking part in physical activity, the association between physical activity and anticoagulation-related bleeding is uncertain.
To determine whether physical activity is associated with bleeding in elderly patients taking anticoagulants.
PATIENTS/METHODS: In a prospective multicenter cohort study of 988 patients aged ≥ 65 years receiving anticoagulants for venous thromboembolism, we assessed patients' self-reported physical activity level. The primary outcome was the time to a first major bleeding, defined as fatal bleeding, symptomatic bleeding in a critical site, or bleeding causing a fall in hemoglobin or leading to transfusions. The secondary outcome was the time to a first clinically relevant non-major bleeding. We examined the association between physical activity level and time to a first bleeding by using competing risk regression, accounting for death as a competing event. We adjusted for known bleeding risk factors and anticoagulation as a time-varying covariate.
During a mean follow-up of 22 months, patients with a low, moderate, and high physical activity level had an incidence of major bleeding of 11.6, 6.3, and 3.1 events per 100 patient-years and an incidence of clinically relevant non-major bleeding of 14.0, 10.3, and 7.7 events per 100 patient-years, respectively. A high physical activity level was significantly associated with a lower risk of major bleeding (adjusted sub-hazard ratio 0.40, 95% confidence interval 0.22-0.72). There was no association between physical activity and non-major bleeding.
A high level of physical activity is associated with a decreased risk of major bleeding in elderly patients receiving anticoagulant therapy.
尽管抗凝治疗期间出血的可能性可能限制患者参加体育活动，但体育活动与抗凝相关出血之间的关联尚不确定。
确定体力活动是否与服用抗凝剂的老年患者的出血有关。
患者/方法：在一项对 988 名年龄≥65 岁接受抗凝剂治疗静脉血栓栓塞症的患者进行的前瞻性多中心队列研究中，我们评估了患者的自我报告体力活动水平。主要结局是首次大出血的时间，定义为致命性出血、重要部位有症状性出血或导致血红蛋白下降或需要输血的出血。次要结局是首次临床相关非大出血的时间。我们使用竞争风险回归来检查体力活动水平与首次出血时间之间的关系，将死亡作为竞争事件。我们调整了已知的出血风险因素和作为时间变化的协变量的抗凝。
在平均 22 个月的随访期间，低、中、高体力活动水平的患者大出血发生率分别为每 100 患者年 11.6、6.3 和 3.1 例，临床相关非大出血发生率分别为每 100 患者年 14.0、10.3 和 7.7 例。高体力活动水平与大出血风险降低显著相关（调整后的亚风险比 0.40，95%置信区间 0.22-0.72）。体力活动与非大出血之间没有关联。
在接受抗凝治疗的老年患者中，高水平的体力活动与大出血风险降低相关。
