Landefeld C S, Cook E F, Flatley M, Weisberg M, Goldman L
Am J Med. 1987 Apr;82(4):703-13. doi: 10.1016/0002-9343(87)90004-0.
Among 617 hospitalized patients who started long-term anticoagulant therapy, major bleeding developed before discharge in 28 (5 percent) and minor bleeding in another 38 (6 percent), with daily incidence rates of 0.4 and 0.5 percent, respectively. The most common site of bleeding was gastrointestinal, and one patient died from bleeding. Four independent risk factors for major in-hospital bleeding were identified and weighted using multivariate discriminant analysis in a randomly chosen group of 411 patients: co-morbid conditions other than the indication for anticoagulant therapy (specific signs of heart, liver, or kidney dysfunction, cancer, and severe anemia); the use of heparin to begin therapy in patients age 60 years or older; the intensity of therapy (measured by the maximal prothrombin time or partial thromboplastin time); and liver dysfunction that worsened during treatment. These findings were validated in an independent testing group of 206 patients; the risk factors identified 151 patients at low (1 percent) risk of major bleeding, 33 at moderate (6 percent) risk, and 22 at high (23 percent) risk. The accuracy and clinical impact of this prediction rule should be evaluated further in other hospitals.
在617例开始长期抗凝治疗的住院患者中，28例（5%）在出院前发生大出血，另有38例（6%）发生小出血，日发生率分别为0.4%和0.5%。最常见的出血部位是胃肠道，1例患者死于出血。在随机选取的411例患者中，通过多变量判别分析确定并加权了4个院内大出血的独立危险因素：除抗凝治疗指征外的合并症（心、肝或肾功能不全、癌症及严重贫血的特定体征）；60岁及以上患者开始治疗时使用肝素；治疗强度（通过最大凝血酶原时间或部分凝血活酶时间测量）；以及治疗期间恶化的肝功能不全。这些发现在206例患者的独立测试组中得到验证；这些危险因素识别出151例大出血低风险（1%）患者、33例中度风险（6%）患者和22例高风险（23%）患者。该预测规则的准确性和临床影响应在其他医院进一步评估。
