Wändell Per, Carlsson Axel C, Holzmann Martin, Ärnlöv Johan, Johansson Sven-Erik, Sundquist Jan, Sundquist Kristina
Division of Family Medicine, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Alfred Nobels Allé 12, 141 83, Huddinge, Sweden.
Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden.
Eur J Clin Pharmacol. 2017 Feb;73(2):215-221. doi: 10.1007/s00228-016-2152-8. Epub 2016 Nov 8.
The objective of this study was to study the association between antithrombotic treatment and risk of hemorrhagic stroke (HS) in patients with atrial fibrillation (AF) treated in primary health care.
Study population included all adults (n = 12,215) 45 years and older diagnosed with AF at 75 primary care centers in Sweden 2001-2007. Outcome was defined as a first hospital episode with a discharge episode of HS after the AF diagnosis. Association between HS and persistent treatment with antithrombotic agents (warfarin, acetylsalicylic acid (ASA), clopidogrel) was explored using Cox regression analysis, with hazard ratios (HRs) and 95 % CIs. Adjustment was made for age, socioeconomic status, and co-morbid cardiovascular conditions.
During a mean of 5.8 years (SD 2.4) of follow-up, 162 patients (1.3 %; 67 women and 95 men) with HS were recorded. The adjusted risk associated with persistent warfarin treatment compared to no antithrombotic treatment consistently showed no increased HS risk, HR for women 0.53 (95 % CI 0.23-1.27) and for men 0.55 (95 % CI 0.29-1.04); corresponding HRs for ASA were, for women, 0.45 (95 % CI 0.14-1.44) and, for men, 0.56 (95 % CI 0.24-1.29).
In this clinical setting, we found no evidence pointing to an increased risk of HS with antithrombotic treatment.
本研究旨在探讨在初级卫生保健机构接受治疗的心房颤动（AF）患者中，抗血栓治疗与出血性卒中（HS）风险之间的关联。
研究人群包括2001年至2007年在瑞典75个初级保健中心诊断为AF的所有45岁及以上成年人（n = 12,215）。结局定义为AF诊断后首次因HS出院的住院事件。使用Cox回归分析探讨HS与抗血栓药物（华法林、乙酰水杨酸（ASA）、氯吡格雷）持续治疗之间的关联，并计算风险比（HRs）和95%可信区间（CIs）。对年龄、社会经济状况和合并的心血管疾病进行了校正。
在平均5.8年（标准差2.4）的随访期间，记录了162例HS患者（1.3%；67例女性和95例男性）。与未进行抗血栓治疗相比，持续使用华法林治疗的校正风险始终显示HS风险没有增加，女性的HR为0.53（95%CI 0.23 - 1.27），男性为0.55（95%CI 0.29 - 1.04）；ASA的相应HRs，女性为0.45（95%CI 0.14 - 1.44），男性为0.56（95%CI 0.24 - 1.29）。
在这种临床环境中，我们没有发现证据表明抗血栓治疗会增加HS风险。
