Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK.
Data and Analytical Sciences, Public Health England, London, UK.
BMJ. 2021 Dec 21;375:e068037. doi: 10.1136/bmj-2021-068037.
To estimate the association between untreated, community acquired, respiratory tract infections and bleeding in oral anticoagulant users.
Self-controlled case series.
General practices in England contributing data to the Clinical Practice Research Datalink GOLD.
1208 adult users of warfarin or direct oral anticoagulants with a general practice or hospital admission record of a bleeding event between January 2010 and December 2019, and a general practice record of a consultation for a community acquired respiratory tract infection for which immediate antibiotics were not prescribed (that is, untreated).
Relative incidence of major bleeding and clinically relevant non-major bleeding in the 0-14 days after an untreated respiratory tract infection, compared to unexposed time periods.
Of 1208 study participants, 58% (n=701) were male, median age at time of first bleed was 79 years (interquartile range 72-85), with a median observation period of 2.4 years (interquartile range 1.3-3.8). 292 major bleeds occurred during unexposed time periods and 41 in the 0-14 days after consultation for a respiratory tract infection. 1003 clinically relevant non-major bleeds occurred during unexposed time periods and 81 in the 0-14 days after consultation for a respiratory tract infection. After adjustment for age, season, and calendar year, the relative incidence of major bleeding (incidence rate ratio 2.68, 95% confidence interval 1.83 to 3.93) and clinically relevant non-major bleeding (2.32, 1.82 to 2.94) increased in the 0-14 days after an untreated respiratory tract infection. Findings were robust to several sensitivity analyses and did not differ by sex or type of oral anticoagulant.
This study observed a greater than twofold increase in the risk of bleeding during the 0-14 days after an untreated respiratory tract infection. These findings have potential implications for how patients and clinicians manage oral anticoagulant use during an acute intercurrent illness and warrant further investigation into the potential risks and how they might be mitigated.
评估未经治疗的社区获得性呼吸道感染与口服抗凝剂使用者出血之间的关联。
自身对照病例系列研究。
英格兰的普通诊所，为 Clinical Practice Research Datalink GOLD 提供数据。
2010 年 1 月至 2019 年 12 月期间，1208 名接受华法林或直接口服抗凝剂治疗的成年患者，他们在普通诊所或医院就诊时记录了出血事件，且在该次就诊前，因呼吸道感染就诊，但未立即开具抗生素治疗（即未经治疗）。
与未暴露时期相比，未经治疗的呼吸道感染后 0-14 天内主要出血和临床相关非主要出血的相对发生率。
在 1208 名研究参与者中，58%（n=701）为男性，首次出血时的中位年龄为 79 岁（四分位距 72-85），中位观察期为 2.4 年（四分位距 1.3-3.8）。292 例主要出血发生在未暴露时期，41 例发生在呼吸道感染就诊后的 0-14 天内。1003 例临床相关非主要出血发生在未暴露时期，81 例发生在呼吸道感染就诊后的 0-14 天内。在校正年龄、季节和日历年后，未经治疗的呼吸道感染后 0-14 天内，主要出血（发病率比 2.68，95%置信区间 1.83 至 3.93）和临床相关非主要出血（2.32，1.82 至 2.94）的相对发生率增加。这些发现经过几项敏感性分析后仍然成立，且不受性别或口服抗凝剂类型的影响。
本研究观察到，未经治疗的呼吸道感染后 0-14 天内出血风险增加了两倍以上。这些发现可能会影响患者和临床医生在急性并发疾病期间管理口服抗凝剂的方式，需要进一步研究潜在风险以及如何减轻这些风险。
