Wong David K, Lurie Fedor, Wong Linda L
Department of Surgery, University of Hawaii John A. Burns School of Medicine and Queens Medical Center, Honolulu, Hawaii, USA.
J Trauma. 2008 Dec;65(6):1303-8. doi: 10.1097/TA.0b013e318185e234.
Patients are living longer with cardiovascular disease managed with antiplatelet drugs. These seniors are asked to be more physically active and are prone to falls or injuries. Few have studied the mortality or morbidity from anticoagulants in patients with traumatic brain injuries (TBI). With the increasing use of clopidogrel in the elderly, studies on the consequences of TBI are warranted.
This is a retrospective case-controlled study using a trauma data registry of 3,817 closed head trauma cases (2001-2005). Patients with preinjury use of clopidogrel, aspirin or warfarin, and evidence of traumatic intracranial bleeding were identified (n = 131). These were compared with a frequency-matched control group (n = 178) with similar age, gender, Glasgow Coma Scale, and Injury Severity Scores. Main outcome measure included mortality, hospital or intensive care unit duration, and discharge disposition.
Of 131 patients on anticoagulants, patients on clopidogrel (n = 21) were more likely to die (OR = 14.7; 95% CI: 2.3-93.6) and be discharged to an inpatient long-term facility (OR = 3.25; 95%CI: 1.06-9.96). Length of hospital stay and intensive care unit stay were not different from control. Mortality in aspirin patients (n = 90) and warfarin patients (n = 20) did not differ from control. Warfarin patients had increased hospital and ICU stay (10.6 and 5.3 days) when compared with the control (4.7 and 0.9 days, respectively).
TBI patients on clopidogrel may have increased long-term disability and fatal consequences when compared with patients who are not on these drugs or on other anticoagulants. Patients on clopidogrel should be advised of safety when engaging in potentially dangerous activities to avoid the consequences of TBI.
使用抗血小板药物治疗心血管疾病的患者寿命延长。这些老年人被要求增加身体活动，且容易跌倒或受伤。很少有研究探讨创伤性脑损伤（TBI）患者使用抗凝剂后的死亡率或发病率。随着氯吡格雷在老年人中的使用增加，对TBI后果的研究很有必要。
这是一项回顾性病例对照研究，使用了一个包含3817例闭合性颅脑损伤病例（2001 - 2005年）的创伤数据登记系统。确定了伤前使用氯吡格雷、阿司匹林或华法林且有创伤性颅内出血证据的患者（n = 131）。将这些患者与年龄、性别、格拉斯哥昏迷量表和损伤严重程度评分相似的频率匹配对照组（n = 178）进行比较。主要结局指标包括死亡率、住院或重症监护病房时长以及出院去向。
在131例使用抗凝剂的患者中，使用氯吡格雷的患者（n = 21）更有可能死亡（OR = 14.7；95%CI：2.3 - 93.6），并被转至住院长期护理机构（OR = 3.25；95%CI：1.06 - 9.96）。住院时间和重症监护病房停留时间与对照组无差异。使用阿司匹林的患者（n = 90）和使用华法林的患者（n = 20）的死亡率与对照组无差异。与对照组相比，使用华法林的患者住院和重症监护病房停留时间增加（分别为10.6天和5.3天，而对照组分别为4.7天和0.9天）。
与未使用这些药物或其他抗凝剂的患者相比，使用氯吡格雷的TBI患者可能有更高的长期残疾率和致命后果。应告知使用氯吡格雷的患者在从事潜在危险活动时的安全性，以避免TBI的后果。
