Cantalapiedra A, Gutierrez O, Tortosa J I, Yañez M, Dueñas M, Fernandez Fontecha E, Peñarrubia M J, García-Frade L J
Department of Hematology, Hospital Universitario Río Hortega, Universidad de Valladolid, Valladolid, Spain.
J Thromb Thrombolysis. 2006 Oct;22(2):113-20. doi: 10.1007/s11239-006-8455-3.
Intracranial bleeding is the most severe complication caused by anticoagulant or antiplatelet treatment. The increasing use of this therapy, especially in older people, makes the balance between clinical benefit and bleeding risk an important consideration. A retrospective study of all consecutive 500 intracranial hemorrhages in the West Valladolid area, approximately 220,000 people, during the period 1998 to 2004, was performed. In relation to mortality, predisposing conditions were included, such as age, antithrombotic treatment, arterial hypertension, cancer, blood diseases, vascular malformations, and traumatisms. The incidence of intracranial hemorrhage was 310 per 100,000 per year with a mortality of 30%. Higher mortality was found in antiplatelet-treated patients (44.9%) than in anticoagulated patients (31.1%). This may be related to a different mean age of 78 vs. 71 years. Arterial hypertension was the most frequent risk factor (45.1% in nontreated patients, 60% anticoagulated, and 75.5% antiplatelet). The relative risk of intracranial bleeding in anticoagulated patients was 11.2 (p < 0.001) with an incidence of 0.03% and a median of 14 months since treatment began. The median INR was 3.3. In 40% of the patients the previous five controls were in range. Strict consideration of indications criteria joined to a better control of risk factors may avoid intracranial bleeding episodes.
颅内出血是抗凝或抗血小板治疗引起的最严重并发症。这种治疗方法的使用日益增加，尤其是在老年人中，这使得临床获益与出血风险之间的平衡成为一个重要的考虑因素。对1998年至2004年期间西班牙巴利亚多利德西部地区连续发生的500例颅内出血患者（约22万人）进行了一项回顾性研究。在死亡率方面，纳入了一些诱发因素，如年龄、抗血栓治疗、动脉高血压、癌症、血液疾病、血管畸形和创伤。颅内出血的发生率为每年每10万人中有310例，死亡率为30%。接受抗血小板治疗的患者死亡率（44.9%）高于接受抗凝治疗的患者（31.1%）。这可能与平均年龄不同有关，前者为78岁，后者为71岁。动脉高血压是最常见的危险因素（未治疗患者中为45.1%，接受抗凝治疗患者中为60%，接受抗血小板治疗患者中为75.5%）。接受抗凝治疗的患者发生颅内出血的相对风险为11.2（p<0.001），发生率为0.03%，自开始治疗起的中位数为14个月。国际标准化比值（INR）的中位数为3.3。40%的患者之前的五次检查结果在正常范围内。严格考虑适应证标准并更好地控制危险因素可避免颅内出血事件的发生。
