Intensive Care Unit, Hospital Virgen de Arrixaca, Murcia, Spain.
Med Intensiva. 2012 Nov;36(8):548-55. doi: 10.1016/j.medin.2012.01.004. Epub 2012 Mar 3.
Antiplatelet therapy (AT) is increasingly used for treating or preventing vascular diseases, especially as a consequence of population aging. However, the risks may sometimes outweigh the benefits, mostly in relation to intracranial hemorrhage (ICH). Our aim was to determine whether AT is associated with hematoma enlargement and increased mortality in ICH.
A prospective, observational cohort study.
The Intensive Care Unit (ICU) of Arrixaca University Hospital (Murcia, Spain).
We studied 156 patients admitted with non-traumatic ICH between January 2006 and August 2008.
None.
Demographic data, medical history and clinical and laboratory parameters were recorded, along with hematoma volume upon admission and after 24h, and mortality.
A total of 37 patients (24%) received AT. These subjects were older (69 ± 11 vs. 60 ± 15 years, p=0.001) and more frequently diabetic (38% vs. 15%, p=0.003) than those without AT. We detected no difference in hematoma volume upon admission between the two groups, though the volume was significantly greater after 24h in the AT group (66.7 [IQR 42-110] vs. 27 [4.4-64.6]cm(3), p=0.03), irrespective of surgical intervention. Moreover, hematoma volume increased by more than a third in AT-users (69% vs. 33%, p=0.002), and AT was the only significant predictor of hematoma enlargement. Patients on AT also had higher mortality during their ICU stay (78% vs. 45%, p<0.001). In addition, of the patients with hematoma enlargement, over one-third had higher overall mortality (62.5 vs. 28.8%, p=0.001). Independent risk factors for death were the Glasgow Coma Scale score, blood glucose upon admission, and AT.
Our results show an association between AT and subsequent hematoma enlargement, as well as increased mortality in patients presenting with ICH who were receiving AT.
抗血小板治疗（AT）越来越多地用于治疗或预防血管疾病，尤其是由于人口老龄化所致。然而，风险有时可能大于益处，主要与颅内出血（ICH）有关。我们的目的是确定 AT 是否与 ICH 中的血肿扩大和死亡率增加有关。
前瞻性观察队列研究。
阿利卡萨大学医院（穆尔西亚，西班牙）重症监护病房（ICU）。
我们研究了 2006 年 1 月至 2008 年 8 月期间因非外伤性 ICH 入院的 156 名患者。
无。
记录人口统计学数据、病史以及临床和实验室参数，包括入院时和 24 小时后的血肿量以及死亡率。
共有 37 名患者（24％）接受了 AT。这些患者年龄较大（69±11 岁 vs. 60±15 岁，p=0.001），且更常患有糖尿病（38％ vs. 15％，p=0.003）。两组患者入院时的血肿量无差异，但 AT 组 24 小时后血肿量明显更大（66.7 [IQR 42-110] vs. 27 [4.4-64.6]cm3，p=0.03），无论是否进行手术干预。此外，AT 使用者的血肿量增加了三分之一以上（69％ vs. 33％，p=0.002），且 AT 是血肿扩大的唯一显著预测因素。在 ICU 期间，AT 患者的死亡率也更高（78％ vs. 45％，p<0.001）。此外，血肿扩大的患者中，超过三分之一的患者总死亡率更高（62.5％ vs. 28.8％，p=0.001）。死亡的独立危险因素是格拉斯哥昏迷量表评分、入院时血糖和 AT。
我们的结果表明，接受 AT 的 ICH 患者与随后的血肿扩大以及死亡率增加之间存在关联。
