英国卡迪夫大学医学院Haroon Ahmed团队研究了口服抗凝剂使用者的呼吸道感染和出血风险。2021年12月21日出版的《英国医学杂志》发表了这项成果。
为了评估未经治疗、社区获得的呼吸道感染和口服抗凝剂使用者出血之间的相关性，研究组设计了自我对照的病例系列，英国全科医疗为临床实践研究提供数据。
共招募了1208名成年华法林或直接口服抗凝剂使用者，全科医疗或住院记录显示2010年1月至2019年12月发生出血事件，且社区获得性呼吸道感染咨询均未开具即时抗生素（即未经治疗）。主要观察指标为与未暴露时间段相比，未经治疗的呼吸道感染后0-14天内大出血和临床相关非大出血的相对发生率。
1208名参与者中58%（701例）为男性，首次出血时的中位年龄为79岁，中位观察期为2.4年。292例大出血发生在未暴露的时间段，41例发生在呼吸道感染会诊后的0-14天。1003例临床相关的非大出血发生在未暴露的时间段，81例发生在呼吸道感染会诊后的0-14天。
在对年龄、季节和日历年进行校正后，未经治疗的呼吸道感染后0-14天内，严重出血（发生率比率2.68）和临床相关非严重出血（2.32）的相对发生率增加。研究结果对一些敏感性分析是可靠的，且没有因性别或口服抗凝剂类型而有所不同。
研究结果表明，未经治疗的呼吸道感染后0-14天内出血风险增加两倍以上。这些发现对患者和临床医生在急性并发疾病期间如何管理口服抗凝剂的使用具有潜在的意义，并需要进一步调查潜在风险以及如何减轻这些风险。
附：英文原文
Title: Respiratory tract infection and risk of bleeding in oral anticoagulant users: self-controlled case series
Author: Haroon Ahmed, Heather Whitaker, Daniel Farewell, Julia Hippisley-Cox, Simon Noble
Issue&Volume: 2021/12/21
Abstract:
Objective To estimate the association between untreated, community acquired, respiratory tract infections and bleeding in oral anticoagulant users.
Design Self-controlled case series.
Setting General practices in England contributing data to the Clinical Practice Research Datalink GOLD.
Participants 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).
Main outcome measures 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.
Results 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.
Conclusions 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.
DOI: 10.1136/bmj-2021-068037
Source: https://www.bmj.com/content/375/bmj-2021-068037
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
