Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Surgery. 2010 Oct;148(4):724-9; discussion 729-30. doi: 10.1016/j.surg.2010.07.014. Epub 2010 Aug 21.
Atrial fibrillation prophylaxis with warfarin and strong antiplatelet agent use in cardiovascular diseases has increased the incidence of anticoagulation in the elderly. We studied traumatic intracranial hemorrhage (TICH) in patients ≥55 years of age on anticoagulation and antiplatelet agents in a stable population.
We used a Level 1 Trauma Center registry study comparing TICH in patients on anticoagulation drugs during the index periods 1999 to 2000 (T1) and 2007 to 2008 (T2).
A total of 526 TICH patients were seen in T1 and T2 (age, 77.6 vs 77.5 years; not significant [NS]), with the rate doubling from 6.2% to 12.3% of all trauma activations (P < .01). There was no increase in atrial fibrillation, warfarin use, or CHADS(2) scores in atrial fibrillation patients on anticoagulation therapy. TICH in patients taking antiplatelet agents increased 5-fold (2.2 % vs 10.3%; P < .01). Overall TICH mortality rate was the same (12.4% vs 12.2%, NS). TICH mortality among patients on therapeutic warfarin was greater in T1 (26%; P < .05), but mortality was similar to TICH in patients not on anticoagulants in T2 (19% vs 12.2%, NS), suggesting treatment improved. Prevalence and mortality of TICH in patients on antiplatelet agents were similar to TICH in patients on warfarin.
TICH in patients on anticoagulants is epidemic in patients ≥55 years of age. Despite national trends, our well-served population has not seen an increase in warfarin use for atrial fibrillation. Instead, use of antiplatelet agents has increased and is associated with an increased incidence of TICH.
在心血管疾病中，华法林和强效抗血小板药物用于预防心房颤动会增加老年人的抗凝治疗发生率。我们研究了在稳定人群中接受抗凝和抗血小板药物治疗的≥55 岁患者的创伤性颅内出血（TICH）。
我们使用了 1 个 1 级创伤中心的注册研究，比较了 1999 年至 2000 年（T1）和 2007 年至 2008 年（T2）索引期间接受抗凝药物治疗的患者的 TICH。
在 T1 和 T2 中，共观察到 526 例 TICH 患者（年龄分别为 77.6 岁和 77.5 岁，无显著差异[NS]），所有创伤激活的比例从 6.2%增加到 12.3%（P<.01）。接受抗凝治疗的心房颤动患者中，心房颤动、华法林使用或 CHADS（2）评分无增加。服用抗血小板药物的 TICH 患者增加了 5 倍（2.2% vs. 10.3%；P<.01）。总体 TICH 死亡率相同（12.4% vs. 12.2%，NS）。T1 中接受治疗性华法林治疗的 TICH 患者死亡率更高（26%；P<.05），但与 T2 中未接受抗凝治疗的 TICH 患者死亡率相似（19% vs. 12.2%，NS），提示治疗效果有所改善。服用抗血小板药物的患者的 TICH 发生率和死亡率与服用华法林的患者相似。
在≥55 岁的患者中，接受抗凝治疗的患者的 TICH 呈流行趋势。尽管存在全国性趋势，但我们服务良好的人群中并未看到房颤患者使用华法林的增加。相反，抗血小板药物的使用有所增加，并且与 TICH 发生率的增加有关。
