Risk of major hemorrhage for outpatients treated with warfarin.

OBJECTIVE: To determine the incidence of major hemorrhage among outpatients started on warfarin therapy after the recommendation in 1986 for reduced-intensity anticoagulation therapy was made, and to identify baseline patient characteristics that predict those patients who will have a major hemorrhage. DESIGN: Retrospective cohort study. SETTING: A university-affiliated Veterans Affairs Medical Center. PATIENTS: Five hundred seventy-nine patients who were discharged from the hospital after being started on warfarin therapy. MEASUREMENTS AND MAIN RESULTS: The primary outcome variable was major hemorrhage. In our cohort of 579 patients, there were 40 first-time major hemorrhages with only one fatal bleed. The cumulative incidence was 7% at 1 year. The average monthly incidence of major hemorrhage was 0.82% during the first 3 months of treatment and decreased to 0.36% thereafter. Three independent predictors of major hemorrhage were identified: a history of alcohol abuse, chronic renal insufficiency, and a previous gastrointestinal bleed. Age, comorbidities, medications known to influence prothrombin levels, and baseline laboratory values were not associated with major hemorrhage. CONCLUSIONS: The incidence of major hemorrhage in this population of outpatients treated with warfarin was lower than previous estimates of major hemorrhage measured before the recommendation for reduced-intensity anticoagulation therapy was made, but still higher than estimates reported from clinical trials. Alcohol abuse, chronic renal insufficiency, and a previous gastrointestinal bleed were associated with increased risk of major hemorrhage.

Effects of sentence context on recognition of words through lipreading by deaf children.

Twenty monosyllabic nouns (10 animate, 10 inanimate) were presented in isolation and in three different positions in sentences to 15 profoundly deaf children to determine the effect of context on word intelligibility through lipreading. Isolated words were more intelligible (80%) than were words in sentences (46%). Animate nouns were more intelligible (70%) than inanimate nouns (33%) when used in initial position (as subjects) in sentences. Teacher ratings of children's "general lipreading ability" were correlated more highly with their recognition of words in the test sentences (r = 0.93) than with their recognition of words presented in isolation (r = 0.53). The results indicate that teachers of deaf children could enhance the intelligibility of important words by isolating them from sentences. The results also suggest that some speech-perception difficulties of deaf children could be diagnosed through lipreading tests which are scored on the basis of correctness of "key words" in sentences.