心房颤动患者口服华法林相关脑出血危险因素分析

Analysis of oral warfarin-associated intracerebral hemorrhage in patients with nonvalvular atrial fibrillation

目的分析心房颤动(AF)患者口服华法林相关脑出血危险因素及预后情况,从而减低华法林相关脑出血(WAICH)的发生率与死亡率。方法本研究通过哈尔滨医科大学附属第一医院电子病历系统查找从2015年1月至2017年12月在神经内科、外科住院AF患者WAICH患者20例和AF口服华法林无颅内出血患者30例为调查对象。记录患者基本信息、既往史、危险因素、实验室检查、出院转归等方面进行整理。同样方法搜集无出血组资料。对上述资料进行SAS9.4软件统计学分析。结果经分析,出血组与无出血组在高血压病、缺血卒中史、出血史、治疗时间≤1年、血浆凝血酶原时间(PT)为30.36±22.53、活化部分凝血活酶时间(APTT)为43.88±17.75、国际标准化比值(INR)2.93±1.80、INR异变率、合并使用抗血小板药物、HAS-BLED评分为3.30±0.73有统计学差异(P<0.05),将上述单因素有意义的变量放入多因素Logistic模型中,采用逐步回归,结果表明PT,APTT,治疗时间长短是独立因素。结论高血压病、缺血卒中史、出血史、PT升高、APTT升高、INR增高、有INR异变率、治疗时间≤1年、合并应用抗血小板药物患者、HAS-BLED评分高是非瓣膜房颤(NVAF)患者口服华法林相关脑出血的危险因素;PT增高,APTT增高,治疗时间≤1年为NVAF口服华法林致WAICH的独立危险因素。

Objective To analyze the risk factors and prognosis of warfarin-related cerebral hemorrhage in patients with atrial fibrillation(AF),thereby reducing the incidence and mortality of warfarin-related cerebral hemorrhage(WAICH).Methods This study was conducted through the electronic medical record system of the First Affiliated Hospital of Harbin Medical University.From January 2015 to December 2017,20 patients with WAICH in neurology and surgical hospitalized AF patients and 30 patients with AF oral warfarin without intracranial hemorrhage were investigated object.Record basic information,past history,risk factors,laboratory tests,and discharge of patients.The same method was used to collect no bleeding group data.The above data were statistically analyzed by SAS 9.4 software.Results After analysis,the bleeding group and the non-bleeding group in the history of hypertension,ischemic stroke,bleeding history,treatment time≤1 year,plasma prothrombin time(PT)was 30.36±22.53,activated partial thromboplastin time(APTT)43.88±17.75,international normalized ratio(INR)2.93±1.80,INR rate,combined use of antiplatelet drugs,HAS-BLED score of 3.30±0.73 were statistically significant(P<0.05).The variables were put into the multivariate Logistic model and stepwise regression was used.The results showed that PT,APTT,the length of treatment was an independent factor.Conclusions Hypertension,history of ischemic stroke,history of hemorrhage,elevated PT,elevated APTT,increased INR,INR rate,treatment time≤1 year,combined antiplatelet drugs,high HAS-BLED scores are non-valvular atrial fibrillation(NVAF)patients risk factors for oral WAICH.PT increased,APTT increased,and treatment time≤1 year was an independent risk factor for WAICH caused by oral administration of warfarin in NVAF.