Fong M K, Sheng B, Chu Y P, Wong W T, Lau P Pk, Wong H Y, Lau K K
Department of Medicine and Geriatrics, Princess Margaret Hospital, Laichikok, Hong Kong.
Department of Rehabilitation, Kowloon Hospital, Argyle Street, Hong Kong.
Hong Kong Med J. 2017 Apr;23(2):117-21. doi: 10.12809/hkmj164953. Epub 2017 Feb 24.
Coagulopathy-associated intracerebral haemorrhage has become increasingly common because of the rising demand in the ageing population for anticoagulation for atrial fibrillation. This study compared the clinical features and neurological outcomes of intracerebral haemorrhage in patients with atrial fibrillation who were prescribed warfarin with those who were not.
This was a retrospective matched case series of patients with intracerebral haemorrhage from three tertiary hospitals in Hong Kong from 1 January 2006 to 31 December 2011. Patients who developed intracerebral haemorrhage and who were prescribed warfarin for atrial fibrillation (ICH-W group) were compared with those with intracerebral haemorrhage and not prescribed warfarin (ICH-C group); they were matched for age and gender in 1:1 ratio. Clinical features and neurological outcomes were compared, and the impact of coagulopathy on haematoma size was also studied.
We identified 114 patients in the ICH-W group with a mean age of 75 years. Both ICH-W and ICH-C groups had a median intracerebral haemorrhage score of 2. There was a non-statistically significant trend of higher intracerebral haemorrhage volume in the ICH-W group (12.9 mL vs 10.5 mL). The median modified Rankin Scale and the proportion with good recovery (modified Rankin Scale score ≤3) at 6 months were comparable. Nonetheless, ICH-W patients had higher hospital mortality (51.8% vs 36.0%; P=0.02) and 6-month mortality (60.5% vs 43.0%; P=0.01) than ICH-C patients. Overall, 60% of ICH-W patients had their admission international normalised ratio within the therapeutic range during intracerebral haemorrhage, and 14% had a subtherapeutic admission international normalised ratio. International normalised ratio at admission was not associated with intracerebral haemorrhage volume or neurological outcome.
Warfarin-associated intracerebral haemorrhage in patients with atrial fibrillation carried a higher stroke mortality than the non-warfarinised patients.
由于老年人群中因心房颤动接受抗凝治疗的需求不断增加，凝血功能障碍相关性脑出血已变得越来越常见。本研究比较了服用华法林的心房颤动患者与未服用华法林的心房颤动患者脑出血的临床特征和神经功能结局。
这是一项回顾性配对病例系列研究，研究对象为2006年1月1日至2011年12月31日期间香港三家三级医院的脑出血患者。将发生脑出血且因心房颤动服用华法林的患者（脑出血-华法林组）与发生脑出血但未服用华法林的患者（脑出血-对照组）进行比较；按1:1的比例对年龄和性别进行匹配。比较临床特征和神经功能结局，并研究凝血功能障碍对血肿大小的影响。
我们在脑出血-华法林组中确定了114例患者，平均年龄为75岁。脑出血-华法林组和脑出血-对照组的脑出血评分中位数均为2。脑出血-华法林组的脑出血量有更高的趋势，但无统计学意义（12.9 mL对10.5 mL）。6个月时改良Rankin量表中位数及恢复良好（改良Rankin量表评分≤3）的比例相当。尽管如此，脑出血-华法林组患者的医院死亡率（51.8%对36.0%；P=0.02）和6个月死亡率（60.5%对43.0%；P=0.01）高于脑出血-对照组患者。总体而言，60%的脑出血-华法林组患者在脑出血期间入院国际标准化比值在治疗范围内，14%的患者入院国际标准化比值低于治疗范围。入院时国际标准化比值与脑出血量或神经功能结局无关。
心房颤动患者中与华法林相关的脑出血比未服用华法林的患者具有更高的卒中死亡率。
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