Mikkola K M, Patel S R, Parker J A, Grodstein F, Goldhaber S Z
School of Medicine, Lund University, Sweden.
Am Heart J. 1997 Jul;134(1):69-72. doi: 10.1016/s0002-8703(97)70108-x.
We reviewed our database of 312 patients with pulmonary embolism who received thrombolysis in five clinical trials. At baseline, none had a history of stroke, internal bleeding within 6 months, surgery within 10 days, or occult blood in stool. Sixty-six major bleeding episodes occurred within 72 hours of administering thrombolysis in 61 (20%) patients: bleeding at the catheterization site (34 cases), gross hematuria (9), intracranial hemorrhage (5), and 18 other bleeding episodes that led to at least a 10% hematocrit decrease. Patients with a major bleeding complication were on average older than patients with no hemorrhagic complication (mean age 62.9 +/- 1.9 years vs 56.2 +/- 1.1 years; p = 0.005). In an adjusted analysis, there was a fourfold increased risk of bleeding among patients older than 70 years compared with patients younger than 50 years (relative risk [RR] 3.9; 95% confidence interval [CI] 1.7 to 8.9). By using age as a continuous variable, we found a 4% (RR 1.04; 95% CI 1.02 to 1.06) increase in risk of bleeding for each incremental year of age. In addition, patients with higher body mass index had an increased risk of bleeding. Patients who had undergone catheterization had a five times greater risk of bleeding (RR 5.2; 95% CI 1.5 to 17.8). In summary, increasing age, larger body mass index, and catheterization predisposed to bleeding complications after pulmonary embolism thrombolysis.
我们回顾了我们数据库中312例在五项临床试验中接受溶栓治疗的肺栓塞患者。基线时，无一例有中风病史、6个月内有内出血、10天内有手术史或大便潜血。61例（20%）患者在溶栓治疗后72小时内发生了66次严重出血事件：导管插入部位出血（34例）、肉眼血尿（9例）、颅内出血（5例）以及其他18次导致血细胞比容至少降低10%的出血事件。发生严重出血并发症的患者平均年龄高于无出血并发症的患者（平均年龄62.9±1.9岁对56.2±1.1岁；p=0.005）。在一项校正分析中，70岁以上患者的出血风险比50岁以下患者增加了四倍（相对风险[RR]3.9；95%置信区间[CI]1.7至8.9）。将年龄作为连续变量，我们发现年龄每增加一岁，出血风险增加4%（RR 1.04；95%CI 1.02至1.06）。此外，体重指数较高的患者出血风险增加。接受过导管插入术的患者出血风险高五倍（RR 5.2；95%CI 1.5至17.8）。总之，年龄增加、体重指数增大和导管插入术易导致肺栓塞溶栓后出血并发症。
