Prognostic implications of warfarin cessation after major trauma - A population-based cohort analysis

Article

关键词: NONVALVULAR ATRIAL-FIBRILLATION;    LONG-TERM;    ANTITHROMBOTIC THERAPY;    MYOCARDIAL-INFARCTION;    ANTICOAGULANT-THERAPY;    SECONDARY PREVENTION;    PHYSICIAN ATTITUDES;    PREINJURY WARFARIN;    STROKE PREVENTION;    ELDERLY-PATIENTS;   

DOI  :  10.1161/01.CIR.0000163548.38396.E7

来源: SCIE

【 摘 要 】

Background-Warfarin therapy is often withheld from elderly patients who fall or otherwise experience injury because of concerns regarding the long-term risk of hemorrhage in these individuals. We studied whether stopping warfarin after trauma is associated with a higher risk of subsequent adverse cardiovascular events. Methods and Results-We conducted a retrospective, population-based, cohort study using linked administrative databases in the province of Ontario, Canada for the years 1992 to 2001. A total of 8450 elderly patients (age > 65 years) who survived an incident of major trauma and were receiving warfarin before injury were followed up for a mean of 3.3 years. During the 6-month interval after trauma, 1827 (22%) patients discontinued warfarin, whereas 6623 (78%) patients continued warfarin. Warfarin cessation was not associated with an increased risk of subsequent stroke ( hazard ratio [HR] 0.99, 95% CI 0.82 to 1.21) or myocardial infarction (HR 0.94, 95% CI 0.74 to 1.20) but was associated with a lower risk of major hemorrhage (HR 0.69, 95% CI 0.54 to 0.88) and a higher risk of venous thromboembolism ( HR 1.59, 95% CI 1.07 to 2.36). Adjustment for baseline demographics, stroke risk factors, other comorbidities, and characteristics of the trauma did not materially change these findings. On-treatment analyses yielded similar results. Conclusions-Cessation of warfarin in elderly patients after major trauma was not associated with an increased risk of arterial thrombotic events but was associated with a significantly increased risk of venous thromboembolism.

【 授权许可】

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