Golob Joseph F, Sando Mark J, Kan Justin C, Yowler Charles J, Malangoni Mark A, Claridge Jeffrey A
MetroHealth Medical Center, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH 44109-1998, USA.
Surgery. 2008 Oct;144(4):591-6; discussion 596-7. doi: 10.1016/j.surg.2008.06.022. Epub 2008 Aug 29.
Trauma patients who require therapeutic anticoagulation pose a difficult treatment problem. The purpose of this study was to determine: (1) the incidence of complications using therapeutic anticoagulation in trauma patients, and (2) if any patient factors are associated with these complications.
An 18-month retrospective review was performed on trauma patients >or= 15 years old who received therapeutic anticoagulation using unfractionated heparin (UH) and/or fractionated heparin (FH). Forty different pre-treatment and treatment patient characteristics were recorded. Complications of anticoagulation were documented and defined as any unanticipated discontinuation of the anticoagulant for bleeding or other adverse events.
One-hundred-fourteen trauma patients were initiated on therapeutic anticoagulation. The most common indication for anticoagulation was deep venous thrombosis (46%). Twenty-four patients (21%) had at least 1 anticoagulation complication. The most common complication was a sudden drop in hemoglobin concentration requiring blood transfusion (11 patients). Five patients died (4%), 3 of whom had significant hemorrhage attributed to anticoagulation. Bivariate followed by logistic regression analysis identified chronic obstructive pulmonary disease (OR = 9.2, 95%CI = 1.5-54.7), UH use (OR = 3.8, 95%CI = 1.1-13.0), and lower initial platelet count (OR = 1.004, 95%CI = 1.000-1.008) as being associated with complications. Patients receiving UH vs. FH differed in several characteristics including laboratory values and anticoagulation indications.
Trauma patients have a significant complication rate related to anticoagulation therapy, and predicting which patients will develop a complication remains unclear. Prospective studies are needed to determine which treatment regimen, if any, is appropriate to safely anticoagulate this high risk population.
需要进行治疗性抗凝的创伤患者带来了一个棘手的治疗问题。本研究的目的是确定：（1）创伤患者使用治疗性抗凝的并发症发生率，以及（2）是否有任何患者因素与这些并发症相关。
对15岁及以上接受普通肝素（UH）和/或低分子肝素（FH）进行治疗性抗凝的创伤患者进行了为期18个月的回顾性研究。记录了40种不同的治疗前和治疗期间患者特征。记录抗凝并发症，并将其定义为因出血或其他不良事件导致抗凝剂意外停用的任何情况。
114例创伤患者开始接受治疗性抗凝。抗凝最常见的指征是深静脉血栓形成（46%）。24例患者（21%）至少发生1次抗凝并发症。最常见的并发症是血红蛋白浓度突然下降需要输血（11例患者）。5例患者死亡（4%），其中3例死于与抗凝相关的严重出血。双变量分析后进行逻辑回归分析确定慢性阻塞性肺疾病（OR = 9.2，95%CI = 1.5 - 54.7）、使用UH（OR = 3.8，95%CI = 1.1 - 13.0）和较低的初始血小板计数（OR = 1.004，95%CI = 1.000 - 1.008）与并发症相关。接受UH与FH治疗的患者在包括实验室值和抗凝指征等几个特征方面存在差异。
创伤患者抗凝治疗的并发症发生率较高，而预测哪些患者会发生并发症仍不清楚。需要进行前瞻性研究以确定哪种治疗方案（如果有的话）适合对这一高风险人群进行安全抗凝。
