并不是所有的创伤性脑损伤患者在受伤前的抗凝药是相同的
Sai Krishna Bhogadi1, Qaidar Alizai1, Christina Colosimo1
1Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA.
American journal of surgery
|June 10, 2023
概括
创伤性脑损伤 (TBI) 患者使用的抗凝剂类型会影响诸如内出血 (ICH) 进展和神经外科干预 (NSI) 的需要等结果. 特别是华法林与TBI患者的结果更差有关.
科学领域:
- 神经创伤是一种神经创伤.
- 药理学 药理学是指药理学的学科.
- 临床结果 临床结果
背景情况:
- 在创伤性脑损伤 (TBI) 患者中,各种抗凝剂的预后意义尚未得到充分确立.
- 抗凝剂的使用在患有TBI的老年患者中很常见,因此需要了解它们对结果的影响.
研究的目的:
- 为了比较不同抗凝剂对TBI患者结局的影响.
- 调查抗凝剂类型与内出血 (ICH) 进展以及神经外科干预 (NSI) 的需要之间的关联.
主要方法:
- 使用来自AAST BIG MIT研究的数据进行了二次分析.
- 确定了50岁或以上使用抗凝药并出现ICH的形TBI患者.
- 评估的结果包括ICH进展和NSI的要求.
主要成果:
- 该研究确定了393名患者,平均年龄为74岁. 阿司匹林是最常见的抗凝剂 (30%),其次是克洛皮多格雷尔 (普拉维克斯,28%) 和华法林 (库马丁,20%).
- 内出血进展发生在20%的患者中,10%的患者需要NSI.
- 多变量回归表明,华法林,下血瘤 (SDH),内出血 (IPH),下arachnoid出血 (SAH),酒精中毒和神经检查恶化与ICH进展的几率增加有关. 华法林,呈现时的神经检查异常和SDH是NSI的独立预测因素.
结论:
- 这些发现突出了抗凝剂类型,出血模式和TBI后患者的结果之间的复杂相互作用.
- 未来对临床管理指南的修改,例如脑损伤指南 (BIG),可能需要纳入患者使用的特定类型的抗凝剂.
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