口服抗凝剂逆转和创伤患者的死亡率:一个多中心倾向得分匹配的队列研究
Elodie Lang1, Marion Gautier1, Jean-Luc Hanouz2
1Department of Anesthesiology and Critical Care, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.
EClinicalMedicine
|October 28, 2025
概括
口服抗凝剂 (OAC) 治疗增加创伤死亡率,特别是使用维生素K对抗剂 (VKA). 符合指导方针的逆转可降低OAC创伤患者的死亡率,而不会增加血栓形成风险,但未得到充分利用.
科学领域:
- 创伤护理的护理人员.
- 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:
- 口服抗凝剂 (OAC) 治疗与增加出血风险有关.
- OACs对创伤结果的影响和逆转策略的有效性仍然不清楚.
- 在创伤患者中使用创伤前OAC需要进一步调查死亡率和血栓形成风险.
研究的目的:
- 评估受伤前OAC治疗对创伤死亡率的影响.
- 评估OAC逆转在创伤患者中的保护作用.
- 在创伤患者中确定与OAC逆转相关的血栓形成风险.
主要方法:
- 一项使用前性多中心创伤登记的观察性研究 (2012年1月 - 2023年12月).
- 倾向性得分匹配用于比较OAC治疗和非OAC治疗的创伤患者.
- 后勤回归分析评估了死亡率,并评估了符合指南的OAC逆转的影响,并记录了血栓性并发症.
主要成果:
- 在创伤患者中,OAC治疗与第1天和第7天死亡率 (分别为OR 2.21和2.06) 的增加有关.
- 维生素K对抗剂 (VKA) 存在比直接口服抗凝剂 (DOAC) 更大的死亡风险.
- 在21%的病例中使用与指导方针一致的OAC逆转,显著降低了1日和7日死亡率 (分别为0.10和0.51的OR),而不会增加血栓形成的风险.
结论:
- 伤害前的OAC治疗显著增加创伤死亡率,特别是VKA.
- 与指导方针一致的OAC逆转可以降低创伤患者 (VKA和DOAC用户) 的死亡率,而不会增加血栓形成的风险.
- 由于OAC逆转策略未得到充分利用,因此需要在接受OAC治疗的创伤患者中系统地实施.
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