抗凝血治疗心脏动后的出血和新恶性病症诊断:基于人口的队列研究
Kavi Grewal1,2, Xuesong Wang3, Peter C Austin4,3
1Temerty Faculty of Medicine (K.G.), University of Toronto, Canada.
Circulation
|February 20, 2025
概括
接受抗凝药治疗的老年心房患者的出血与癌症风险增加了4倍. 及早检查出血是非常重要的,因为它可能表明恶性并导致早期癌症诊断.
科学领域:
- 癌症学
- 心脏病学
- 老年病学
背景情况:
- 抗凝血治疗心房 (AF) 后的出血可能是恶性瘤的早期指标,特别是在老年人中.
- 目前的指导方针缺乏针对服用抗凝药的AF患者新发出出血后的恶性瘤的具体建议.
研究的目的:
- 调查AF的口服抗凝药开始后的出血与随后的恶性瘤新诊断之间的联系.
- 为了确定出血事件是否预测大量的全民癌症.
主要方法:
- 一项基于人口的队列研究利用了2008年至2022年的相关行政数据.
- 包括66岁以上的新开始服用华法林或DOAC的患者,不包括先前患有癌症,特定疾病或出血的患者.
- 随访时间为2年,在因果特定的回归模型中,出血是随时间变化的共变量.
主要成果:
- 在119,480名患者中,21. 8%的患者出现出血,4. 9%的患者在2年内被诊断为恶性瘤.
- 出血与癌症诊断的风险显著增加 (HR 4. 0, 95% CI 3. 8- 4. 3).
- 特定的出血部位显示出不同的癌症关联,一致的部位具有更高的HR (例如GI:15. 4). 癌症是在出血后的早期阶段被诊断出来的 (27.6%是第四阶段而不是31. 3%).
结论:
- 抗凝血AF患者的出血与新的癌症诊断密切相关.
- 前例出血与早期癌症检测有关.
- 及时调查该群体的出血事件至关重要,而不是将其视为抗凝药的副作用.
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