抗凝固疗法和严重创伤性脑损伤:使用TriNetX对临床结果的回顾性队列研究
Spencer Rasmussen1, Kamal Shaik1, Clayton Rawson2
1Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, PA 19104, USA.
Journal of clinical medicine
|July 12, 2025
概括
在受伤前使用直接口服抗凝剂 (DOAC) 或维生素K对抗剂 (VKA) 并没有增加严重创伤性脑损伤 (STBI) 患者的死亡率. 目前的管理策略似乎对抗凝血药治疗的sTBI患者是安全的.
科学领域:
- 神经科学是一个神经科学.
- 药理学 药理学是指药理学的学科.
- 公共卫生 公共卫生
背景情况:
- 创伤性脑损伤 (TBI) 是导致死亡和残疾的重要原因.
- 抗凝血疗法增加了TBI死亡风险,但DOAC和VKA对严重TBI (sTBI) 的具体影响尚不清楚.
- 较新的逆转剂的作用增加了对抗凝固药STBI患者的管理的复杂性.
研究的目的:
- 评估STBI患者的长期死亡率和并发症风险,在受伤之前使用DOAC或VKA.
- 用回顾性数据分析大量现实世界队列中的结果.
- 为了比较患者在DOACs,VKAs和没有抗凝药的结果.
主要方法:
- 使用 TriNetX 全球研究网络 (2016-2022) 的回顾性队列研究.
- 包括患有STBI的患者,按受伤前使用抗凝剂分类 (DOAC,VKA,没有).
- 根据年龄,并发症和基线特征调整的倾向性得分匹配;主要结果:1,3,6,12个月的所有原因死亡率;次要结果:30天内的并发症.
主要成果:
- 这项研究包括了40,563名sTBI患者.
- 在任何时间间隔 (1,3,6,12个月) 中,在倾向性得分匹配的组之间没有观察到所有原因死亡率的显著差异.
- 在短期住院或手术并发症方面没有发现显著差异.
结论:
- 在受伤前使用DOAC或VKA与STBI患者的短期或长期死亡率增加无关.
- 目前的外科手术实践允许在sTBI中安全管理抗凝剂.
- 结果支持在适当时继续使用抗凝剂,即使在患有STBI的患者中也是如此.
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