静脉瘤手术后持续性静脉鼻血栓形成:我们应该使用抗凝剂吗?
Chady Omara1, Marco Mammi2, Magnar Kvilhaug3
1Computational Neuroscience Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
World neurosurgery
|June 5, 2024
概括
在前庭神经瘤 (VS) 手术后持续静脉鼻血栓形成 (DVST) 是常见的,通常是无症状的. 目前的证据不支持对DVST的常规抗凝药,需要进一步研究最佳治疗策略.
科学领域:
- 神经外科 神经外科
- 神经学 神经学
- 放射学 放射学是一门学科.
背景情况:
- 静脉瘤 (VS) 手术后的持续静脉瘤 (DVST) 是一个研究不足的并发症.
- 多样化的DVST临床表现使标准化抗凝治疗指南的制定变得复杂.
- 这一元分析涉及VS手术后的DVST发生率,并评估抗凝剂的疗效.
研究的目的:
- 为了确定VS手术后DVST的发生率.
- 评估抗凝治疗在管理DVST后VS手术中的作用和影响.
- 为未来的治疗方案提供基于证据的见解.
主要方法:
- 按照PRISMA指南进行了系统审查和元分析.
- 包括报告VS手术后DVST发生率的研究,DVST检测方法作为主要结果.
- 与抗凝剂相比没有抗凝剂相关的不良事件是二次结果,使用随机效应模型进行分析.
主要成果:
- 在10项研究中,VS切除后DVST的总发病率为15.5% (95%CI:10.3%,22.5%).
- 根据检测方法发生率有所不同:29.4% (MRI),8.2% (CT) 和0.7% (临床怀疑).
- 抗凝药 (16.1%) 与不服用抗凝药 (4.4%) 相比,不良事件的发生率更高,包括后者组的一次死亡.
结论:
- 在VS手术后的DVST比以前想象的更为普遍,通常呈现无症状.
- 对DVST的抗凝血方案不一致,目前的证据不支持其常规使用.
- 需要使用严格的方法进行进一步的比较研究,以确定VS手术后DVST的最终治疗指南.
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