在老年急诊室的患者中,在受伤前的XA因子抑制剂上,患有头创伤的患者的结果
Bailey K Pierce1, Scott M Alter1, Lisa M Clayton1
1Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; Department of Emergency Medicine, Delray Medical Center, Delray Beach, Florida; Department of Emergency Medicine, Bethesda Hospital East, Boynton Beach, Florida.
The Journal of emergency medicine
|July 8, 2025
概括
像XA因子抑制剂这样的直接口服抗凝剂在老年人中不会增加内出血或死亡风险. 这项研究表明,当前的指导方针可能对这种患者群体中的这些药物过于谨慎.
科学领域:
- 老年急救医学的医学
- 药理学 药理学是指药理学的学科.
- 神经学 神经学
背景情况:
- 直接口服抗凝剂 (DOACs) 可能会导致内出血 (ICH) 和头创伤患者的死亡风险.
- 现有研究受到小样本和回顾性设计的限制,需要进一步调查.
研究的目的:
- 评估直接XA因子抑制剂与老年人 (≥65岁) 脑内出血和死亡风险之间的关联.
- 为老年头部创伤患者提供基于证据的指导来管理抗凝药.
主要方法:
- 对一项大型队列研究的二次分析,该研究涉及老年急诊室患者,这些患者患有重头部创伤.
- 纳入标准:65岁以上的头部受伤患者,不包括服用除阿皮克萨班和里瓦罗克萨班以外的抗凝血剂/抗血小板药物的患者.
- 结果 (ICH,30天死亡率) 通过头部CT,电话随访,病历和死亡登记册进行评估;因子XA抑制剂使用者和非使用者之间的结果比较的几率比率.
主要成果:
- 在3031名符合条件的患者中,有2294人没有服用抗凝药,505人接受了阿皮克萨班,232人接受了里瓦罗克萨班.
- ICH发生在7.1%的非抗凝血患者和6.2%的XA因子抑制剂使用者中 (p=0.443).
- 非抗凝血患者的30天死亡率为6.8%,XA抑制剂使用者为7.9% (p=0.345).
结论:
- 克萨因子抑制剂与老年人脑内血流风险的增加没有关联,老年人脑中受到了的头部创伤.
- 这些发现表明,与一些现有的担忧相反,XA因子抑制剂可能在这个人群中安全使用.
- 需要进一步的研究来证实这些发现,并完善临床指南.
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