RESUMO
Objective:To analyze the risk factors associated with hemorrhagic complications at the puncture site after femoral artery access cerebrovascular interventions and construct a bleeding risk scale.Methods:Two hundred and fifteen patients who underwent femoral artery puncture interventions in the neurointerventional department ward of the First Affiliated Hospital of Zhengzhou University from April to October 2020 were selected for the study, including 60 cases in the complication group and 155 cases in the control group. The patients′ general data, interventional procedure-related data and laboratory tests were analyzed univariately and then incorporated into a binary multi-factor logistic regression analysis to determine independent risk factors, and a bleeding risk scale was constructed according to the regression model.Results:Compared with the control group, there was a statistically significant increase in the incidence of women, diabetes mellitus, use of glucose-lowering drugs, proportion of (anticoagulant/antiplatelet drugs) use and irritability in the complication group ( χ2 values were 4.94-15.81, all P<0.05); age, BMI, HbA1c, prothrombin time activity, and sheath size and operative time were higher than those of the control group, and prothrombin time and creatinine values were lower than those of the control group, with statistically significant differences ( t values of -6.25 to 2.80, respectively, all P<0.05). Multifactorial logistic regression analysis showed that gender ( OR=0.09, 95% CI 0.025-0.302), BMI ( OR=1.736, 95% CI 1.462-2.115), HbA1c ( OR=1.775, 95% CI 1.107-2.845), and use of anticoagulant/antiplatelet drugs ( OR= 0.082, 95% CI 0.015- 0.448) and time to surgery ( OR=1.031, 95% CI 1.012-1.052) were independent risk factors for bleeding complications. In the risk scale: the total score was -3 to 13, and risk existed for a score ≥5. The sensitivity of this scale was 83.3%, the specificity was 92.3%, and the area under the ROC curve was 0.878 ( P<0.001, 95% CI 0.818 to 0.938). Conclusions:Female, high BMI, high HbA1c, anticoagulant/antiplatelet drug use, and long procedure time can increase the risk of bleeding complications at the femoral artery puncture. The predictive model has good predictive performance and can be extended for use.
RESUMO
OBJECTIVE: To conduct a retrospective cohort study and determine the influence of the vitamin K epoxide reductase complex subunit 1 (VKORC1) gene alleles on over anticoagulation and bleeding complication in Chinese population. METHODS: Patients who underwent heart valve replacement operation in Cardiovascular Surgery of Fujian Provincial Hospital between January 2011 and August 2013 were included, who took warfarin at least 3 months and whose INR level was controlled between 1.8 and 2.5. Genotypes of VKORC1-1639 G>A were tested by polymerase chain reaction (PCR)-gene sequencing technique. SPSS19.0 software was used to analyze the association between genotypes andwarfarin bleeding complications, adjusted for demographic and clinical factors. RESULTS Totally 196 patients were included, mean age (50.8 ± 10.7) years, 80 males, average follow-up (26.9 ± 11.8) months. Of the 434 patient-year, 18 severe bleeding and 59 minor bleeding occurred in 31patients. Patients with VKORC1-1639 AA were associated with higher bleeding risk than G carriers (HR 3.14; 95% CI: 1.14-8.68). Meanwhile, Kaplan-Meier survival curve showed that time to bleeding evens of VKORC1-1639 AA carriers was shorter than G-carriers(Log-rank test, P=0.03). CONCLUSION: VKORC1-1639 G > A might be the major predictive factor of bleeding complication for warfarin therapy in Chinese patients.