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重度のトラウマ後のワーファリン停止の予後的な影響:人口ベースのコホート分析
Daniel G Hackam1, Alexander Kopp, Donald A Redelmeier
1Division of Clinical Pharmacology, University of Toronto, Toronto, ON, Canada,
Circulation
|April 27, 2005
まとめ
高齢患者の重度のトラウマ後のワーファリン投与を中止すると,動脈血栓症が増加することはありませんでした. しかし,ワルファリンの投与を中止することは,静脈性血栓塞栓症のリスクの増加と関連していました.
科学分野:
- ゲリアトリック・メディシン (老年医学)
- 心血管医学は,心臓血管医学である.
- 薬理学 薬理学とは
背景:
- ウォルファリン療法は,出血の懸念のために,トラウマ後の高齢の患者にしばしば拒否されます.
- 負傷後の心血管疾患にウォルファリン投与を中止した後の影響は十分に理解されていません.
研究 の 目的:
- 高齢のトラウマ患者におけるワルファリンの使用停止と,その後の心血管疾患による有害事象との関連性を調査する.
主な方法:
- カナダ・オンタリオ州の行政データベース (1992年-2001年) を用いた人口ベースのコホート研究.
- ウォルファリンを受けた8450人の高齢患者 (>65歳) が,重度のトラウマを生き延びた.
- トラウマ後の結果を評価するために,平均3.3年間,患者を追跡した.
主要な成果:
- トラウマ後6ヶ月以内にワルファリン投与を中止した患者は22%でした.
- ワルファリン投与の停止は,脳卒中や心筋梗塞のリスクの増加と関連しませんでした.
- ワルファリン投与を中止すると出血のリスクが低く,静脈血栓塞栓症のリスクが高くなります.
結論:
- 高齢のトラウマ患者のワーファリン投与を中止すると,動脈血栓症が増加することはありません.
- 重度のトラウマ後のワルファリンの停止は,静脈性血栓塞栓症のリスクを大幅に増加させる.
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