Batchelor John Stephen, Grayson Alan
Department of Emergency Medicine, Manchester Royal Infirmary Foundation Trust, Oxford Road, Manchester, England.
Br J Neurosurg. 2013 Feb;27(1):12-8. doi: 10.3109/02688697.2012.705361. Epub 2012 Aug 17.
Anticoagulation abnormalities have been recognized for several decades as potential risk factors for increasing the risk of traumatic intracranial haemorrhage in patients with blunt head trauma. The potential increased risk of death as a consequence has not been fully evaluated. The aim of the study was to perform a meta-analysis in order to evaluate based upon the current level of evidence whether the use of pre-injury aspirin or clopidogrel increases the risk of mortality in patients with blunt head trauma.
The databases Medline and EMBASE were searched via the Ovid interface. The Medline database was also searched using the PubMed interface. Case control studies or nested case control studies were identified comparing mortality rates on patients with blunt head trauma in patients on aspirin or clopidogrel against patients not on antiplatelet agents.
Five studies in total were identified as suitable for the meta-analysis. Four of these studies were suitable for the aspirin meta-analysis and four for the clopidogrel meta-analysis. The common odds ratio for the aspirin meta-analysis using the Random Effects model was found to be 2.435 (95% CI: 0.637-9.314). Significant heterogeneity was present I(2) = 79.521. The common odds ratio for the clopidogrel meta-analysis using the Random Effects model was found to be 1.554 (95% CI: 0.320-7.536). Significant heterogeneity was present I(2) = 69.090.
In summary, this meta-analysis showed a slight increased risk of death in patients with blunt head trauma who were taking pre-injury antiplatelet agents although the results did not reach statistical significance. In view of the small number of low level studies from which this meta-analysis is based, further work is required in this area.
几十年来，抗凝异常一直被认为是钝性头部创伤患者创伤性颅内出血风险增加的潜在危险因素。由此导致的潜在死亡风险增加尚未得到充分评估。本研究的目的是进行一项荟萃分析，以便根据当前证据水平评估伤前使用阿司匹林或氯吡格雷是否会增加钝性头部创伤患者的死亡风险。
通过Ovid界面检索Medline和EMBASE数据库。还使用PubMed界面检索了Medline数据库。纳入病例对照研究或巢式病例对照研究，比较服用阿司匹林或氯吡格雷的钝性头部创伤患者与未服用抗血小板药物患者的死亡率。
共确定五项研究适合进行荟萃分析。其中四项研究适合阿司匹林荟萃分析，四项适合氯吡格雷荟萃分析。使用随机效应模型进行阿司匹林荟萃分析的共同比值比为2.435（95%CI：0.637 - 9.314）。存在显著异质性I(2)=79.521。使用随机效应模型进行氯吡格雷荟萃分析的共同比值比为1.554（95%CI：0.320 - 7.536）。存在显著异质性I(2)=69.090。
总之，本荟萃分析表明，伤前服用抗血小板药物的钝性头部创伤患者死亡风险略有增加，尽管结果未达到统计学显著性。鉴于本荟萃分析所基于的低水平研究数量较少，该领域需要进一步开展工作。
