Cothren C Clay, Biffl Walter L, Moore Ernest E, Kashuk Jeffry L, Johnson Jeffrey L
Department of Surgery, Denver Health Medical Center, Denver, CO 80204, USA.
Arch Surg. 2009 Jul;144(7):685-90. doi: 10.1001/archsurg.2009.111.
We hypothesize that the 2 antithrombotic treatment regimens, systemic heparin sodium vs antiplatelet agents, are equivalent for the treatment of blunt cerebrovascular injuries (BCVIs) to prevent devastating injury-related strokes.
Retrospective review of a prospective database.
Level I trauma center.
Patients with BCVIs from January 1, 1997, to January 1, 2007.
Incidence of cerebrovascular accident (CVA), stratified by treatment.
During the study period, 422 BCVIs were identified in 301 patients (64.8% men; mean [SEM] age, 37.0 [0.8] years; mean [SEM] injury severity score, 27.0 [0.9]). A total of 22 patients presented with neurologic ischemia, and 5 patients sustained CVAs after embolization and/or stenting of an injury. Treatment was initiated for 282 asymptomatic BCVIs (heparin, 192; aspirin, 67; aspirin and/or clopidogrel, 23); 1 patient had a CVA (0.5%). Of 107 patients with untreated, asymptomatic BCVIs, 23 (21.5%) had a CVA. For untreated patients sustaining BCVI-related CVAs, the mean (SEM) time to diagnosis was 58 (10) hours. For those who did not exhibit symptoms within 2 hours of injury, mean time to diagnosis of CVA was 75 (11) hours. Injury healing rates (heparin, 39%; aspirin, 43%; aspirin/clopidogrel, 46%) and injury progression rates (12%; 10%; 15%) were equivalent between therapeutic regimens.
With an overall CVA risk of 21% and a documented latent period, comprehensive screening, early diagnosis, and institution of antithrombotic therapy for BCVI are clearly warranted. The type of treatment, heparin vs antiplatelet agents, does not appear to affect either stroke risk or injury healing rates.
我们假设两种抗血栓治疗方案，即全身应用肝素钠与抗血小板药物，在治疗钝性脑血管损伤（BCVI）以预防毁灭性的损伤相关性卒中方面效果相当。
对前瞻性数据库进行回顾性分析。
一级创伤中心。
1997年1月1日至2007年1月1日期间患有BCVI的患者。
按治疗方法分层的脑血管意外（CVA）发生率。
在研究期间，301例患者中确诊422例BCVI（男性占64.8%；平均[标准误]年龄为37.0[0.8]岁；平均[标准误]损伤严重程度评分为27.0[0.9]）。共有22例患者出现神经缺血，5例患者在损伤栓塞和/或支架置入后发生CVA。对282例无症状BCVI患者进行了治疗（肝素治疗192例；阿司匹林治疗67例；阿司匹林和/或氯吡格雷治疗23例）；1例患者发生CVA（0.5%）。107例未经治疗的无症状BCVI患者中，23例（21.5%）发生CVA。对于发生BCVI相关CVA的未治疗患者，平均（标准误）诊断时间为58（10）小时。对于那些在受伤后2小时内未出现症状的患者，CVA的平均诊断时间为75（11）小时。各治疗方案之间的损伤愈合率（肝素治疗为39%；阿司匹林治疗为43%；阿司匹林/氯吡格雷治疗为46%）和损伤进展率（分别为12%、10%、15%）相当。
鉴于总体CVA风险为21%且有明确的潜伏期，显然有必要对BCVI进行全面筛查、早期诊断并实施抗血栓治疗。治疗类型（肝素与抗血小板药物）似乎对卒中风险或损伤愈合率均无影响。
