外腔室排水的去除或更换和预防性抗凝剂在患有动脉瘤下关节出血的患者之间的关联:一个倾向调整的分析
Joshua S Catapano1, Stefan W Koester1, Parth P Parikh1
1Department of Neurosurgery, c/o Neuroscience Publications, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, 350 W. Thomas Rd., Phoenix, AZ, 85013, USA.
Acta neurochirurgica
|June 10, 2023
概括
在肺动脉瘤下arachnoid出血患者的外部心室排水移除之前,扣留超过一个剂量的预防性抗凝剂会增加深静脉血栓或肺栓塞的风险,而不会减少出血.
科学领域:
- 神经外科 神经外科
- 血管外科 血管外科
- 临界护理医学 临界护理医学
背景情况:
- 动脉瘤下arachnoid出血 (aSAH) 的管理通常涉及外部心室排水 (EVDs).
- 预防性抗凝血对于预防静脉血栓塞栓症至关重要,但由于出血风险,在去除EVD之前保留其是有争议的.
- 这项研究调查了预防性抗凝药在EVD移除后的出血并发症和血栓栓塞事件的影响.
研究的目的:
- 评估在aSAH患者的EVD去除过程中保留预防性抗凝剂剂量和出血并发症之间的关联.
- 为了确定是否扣留抗凝药会影响EVD移除后深静脉血栓 (DVT) 或肺栓塞 (PE) 的风险.
主要方法:
- 在2014年1月1日至2019年7月31日期间治疗的271名aSAH患者的回顾性分析,这些患者接受了EVD安置.
- 患者的分层是基于预防性抗凝剂剂量为EVD去除而被扣留的数量 (>1对≤1).
- 用倾向调整后勤回归分析来控制混变量,主要结果是消除EVD后的DVT/PE.
主要成果:
- 在271名患者中,有116名 (42.8%) 患者在去除EVD的过程中被扣留了1剂以上的剂量. 六名患者 (2.2%) 经历了与EVD移除相关的出血,17名患者 (6.3%) 患有DVT或PE.
- 没有观察到与EVD相关的出血的显著差异,患者保留了>1剂量,而≤1剂量 (3.5%对1.3%,p=0.41).
- 在调整后,扣留超过1剂抗凝剂与DVT或PE风险增加显著相关 (OR 4.8;95% CI,1.5-15.7;p=0.009).
结论:
- 在患有EVD的aSAH患者中,扣留超过一剂预防性抗凝剂以消除EVD与更高的DVT或PE风险有关.
- 这种做法似乎没有减少导管切除相关出血的发生率.
- 目前关于在aSAH患者中消除EVD的抗凝血管理的指南可能需要重新评估.
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