EHJ：房颤者中断用华法林 血栓栓塞风险升高
2012-01-01 MedSci原创 MedSci原创
MedSci评论： 华法林作为重要的抗凝药物，以往研究只关注抗凝本身，而很少关注药物中断后的结果。本文立足点相当新颖，临床意义也很重大。同样，其它抗凝药物，也值得我们的思考：利伐沙班，阿哌沙班这类新型抗凝剂，如果中断使用，会不会增加血栓风险？相信，最近两年便会有类似的研究结果出现。我们临床工作者，需要不断从前人的研究结果中反思，寻找新的idea。 12月23日，丹麦
| MedSci评论： |
| 华法林作为重要的抗凝药物，以往研究只关注抗凝本身，而很少关注药物中断后的结果。本文立足点相当新颖，临床意义也很重大。同样，其它抗凝药物，也值得我们的思考：利伐沙班，阿哌沙班这类新型抗凝剂，如果中断使用，会不会增加血栓风险？相信，最近两年便会有类似的研究结果出现。我们临床工作者，需要不断从前人的研究结果中反思，寻找新的idea。 |
12月23日，丹麦学者在Eur Heart J发表的一项研究"NCoR1 Is a Conserved Physiological Modulator of Muscle Mass and Oxidative Function"表明，在房颤患者中，中断华法林治疗与治疗中断后前90天内的死亡或血栓-栓塞事件短期风险显著升高相关。
此项回顾性全国人群研究以1997至2008年房颤首次住院后接受华法林治疗的所有患者为受试者。利用泊松回归分析计算血栓-栓子事件的发病率比率（IRR）和全因死亡率。共有49989例接受华法林治疗的房颤患者被纳入研究。
结果显示，共有35396例患者伴有至少一次的华法林治疗中断。治疗中断期间共出现8255例死亡或血栓-栓塞事件；治疗中断后0～90、 91～180、181～270和271～360天期间分别发生427起事件。与之相应的每100患者年粗发病率分别为31.6、17.1、12.3和 11.4。多变量分析显示，治疗中断后前90天间期与死亡或血栓栓塞风险显著升高相关。（生物谷Bioon.com）
Increased short-term risk of thrombo-embolism or death after interruption of warfarin treatment in patients with atrial fibrillation
Jakob Rauns1,6,*, Christian Selmer1, Jonas Bjerring Olesen1, Mette Gitz Charlot1, Anne-Marie S. Olsen1, Ditte-Marie Bretler1.et al.
Aims It is presently unknown whether patients with atrial fibrillation (AF) are at increased risk of thrombo-embolic adverse events after interruption of warfarin treatment. The purpose of this study was to assess the risk and timing of thrombo-embolism after warfarin treatment interruption.
Methods and results A retrospective, nationwide cohort study of all patients in Denmark treated with warfarin after a first hospitalization with AF in the period 1997–2008. Incidence rate ratios (IRRs) of thrombo-embolic events and all-cause mortality were calculated using the Poisson regression analyses. In total, 48 989 AF patients receiving warfarin treatment were included. Of these, 35 396 patients had at least one episode of warfarin treatment interruption. In all, 8255 deaths or thrombo-embolic events occurred during treatment interruption showing an initial clustering of events with 2717, 835, 500, and 427 events occurring during 0–90, 91–180, 181–270, and 271–360 days after treatment interruption, respectively. Correspondingly, the crude incidence rates were 31.6, 17.7, 12.3, and 11.4 events per 100 patient-years. In a multivariable analysis, the first 90-day interval of treatment interruption was associated with a markedly higher risk of death or thrombo-embolism (IRR 2.5; 95% confidence interval 2.3–2.8) vs. the interval of 271–360 days.
Conclusion In patients with AF, an interruption of warfarin treatment is associated with a significantly increased short-term risk of death or thrombo-embolic events within the first 90 days of treatment interruption.
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