伤前抗血栓药物可预测颅内出血进展，但不会使严重创伤性脑损伤的临床结果更差。,Acta Neurochirurgica

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伤前抗血栓药物可预测颅内出血进展，但不会使严重创伤性脑损伤的临床结果更差。
Acta Neurochirurgica ( IF 1.9 ) Pub Date : 2021-03-26 , DOI: 10.1007/s00701-021-04816-0
Teodor Svedung Wettervik ₁ , Samuel Lenell ₁ , Per Enblad ₁ , Anders Lewén ₁

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背景患有合并症的老年创伤性脑损伤 (TBI) 患者在受伤前接受抗血栓药物（抗血小板和/或抗凝剂）治疗的发生率有所增加。在这项研究中，我们的目的是调查伤前抗血栓治疗是否与严重 TBI 患者更严重的颅内出血/损伤进展和临床结果相关。方法在这项回顾性研究中，包括 2008-2018 年在瑞典乌普萨拉大学医院神经重症监护室接受治疗的 844 名 TBI 患者，其中 159 名（19%）接受了抗血栓药物治疗。评估了人口统计学、入院状态、放射学、治疗和结果变量。显着的颅内出血/损伤演变被定义为在第二次计算机断层扫描 (CT) 上看到的出血进展，初次 CT 后紧急神经外科手术，或初次 CT 后死亡。结果使用伤前抗血栓药物的患者年龄显着增加，Charlson 合并症指数更高。他们更常因跌倒而受伤，更常发生急性硬膜下血肿。68 名 (8%) 患者在损伤前接受了抗血小板单药治疗，67 名 (8%) 患者接受了抗凝剂治疗，24 名 (3%) 患者接受了抗血栓药物联合治疗。在多元回归分析中，损伤前抗凝剂（而非抗血小板）与显着的颅内出血/损伤演变独立相关。然而，在多元回归分析中，抗凝剂和抗血小板药物均与死亡率和不利结果无关。结论只有抗凝剂与颅内出血/损伤进展相关，但没有抗血栓剂与较差的临床结果相关。管理，包括早期抗凝剂逆转、紧急神经外科手术的可用性和神经重症监护，可能是减少损伤前抗血栓药物不良反应的重要方面。

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Pre-injury antithrombotic agents predict intracranial hemorrhagic progression, but not worse clinical outcome in severe traumatic brain injury.

BACKGROUND The incidence of traumatic brain injury (TBI) patients of older age with comorbidities, who are pre-injury treated with antithrombotic agents (antiplatelets and/or anticoagulants), has increased. In this study, our aim was to investigate if pre-injury antithrombotic treatment was associated with worse intracranial hemorrhagic/injury progression and clinical outcome in patients with severe TBI. METHODS In this retrospective study, including 844 TBI patients treated at our neurointensive care at Uppsala University Hospital, Sweden, 2008-2018, 159 (19%) were pre-injury treated with antithrombotic agents. Demography, admission status, radiology, treatment, and outcome variables were evaluated. Significant intracranial hemorrhagic/injury evolution was defined as hemorrhagic progression seen on the second computed tomography (CT), emergency neurosurgery after the initial CT, or death following the initial CT. RESULTS Patients with pre-injury antithrombotics were significantly older and with a higher Charlson comorbidity index. They were more often injured by falls and more frequently developed acute subdural hematomas. Sixty-eight (8%) patients were pre-injury treated with monotherapy of antiplatelets, 67 (8%) patients with anticoagulants, and 24 (3%) patients with a combination of antithrombotics. Pre-injury anticoagulants, but not antiplatelets, were independently associated with significant intracranial hemorrhagic/injury evolution in a multiple regression analysis. However, neither anticoagulants nor antiplatelets were associated with mortality and unfavorable outcome in multiple regression analyses. CONCLUSIONS Only anticoagulants were associated with intracranial hemorrhagic/injury progression, but no antithrombotic agent correlated with worse clinical outcome. Management, including early anticoagulant reversal, availability of emergency neurosurgery, and neurointensive care, may be important aspects for reducing the adverse effects of pre-injury antithrombotics.

更新日期：2021-03-26

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