Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
PLoS One. 2013 Jul 12;8(7):e68732. doi: 10.1371/journal.pone.0068732. Print 2013.
In the last decade there has been an increasing use of antiplatelet/anticoagulant agents in the elderly. The aim of the study was to evaluate the association between exposure to anticoagulant/antiplatelet therapy and chronic subdural haematoma-CSDH.
Single institution case-control study involving 138786 patients older than 60 years who visited our academic tertiary care Emergency Department from January 1st 2001 to December 31st 2010. 345 patients with CSDH (cases) were identified by review of ICD-9 codes 432.1 and 852.2x. Case and controls were matched with a 1:3 ratio for gender, age (± 5 years), year of admission and recent trauma. A conditional logistic model was built. A stratified analysis was performed with respect to the presence (842 patients) or absence (536 patients) of recent trauma.
There were 345 cases and 1035 controls. Both anticoagulant and antiplatelet agents were associated with an increased risk of CSDH with an OR of 2.46 (CI 95% 1.66-3.64) and 1.42 (CI 95% 1.07-1.89), respectively. OR was 2.70 (CI 95% 1.75-4.15), 1.90 (CI 95% 1.13-3.20), and 1.37(CI 95% 0.99-1.90) for patients receiving oral anticoagulants, ADP-antagonists, or Cox-inhibitors, respectively. History of recent trauma was an effect modifier of the association between anticoagulants and CSDH, with an OR 1.71 (CI 95% 0.99-2.96) for patients with history of trauma and 4.30 (CI 95% 2.23-8.32) for patients without history of trauma.
Anticoagulant and antiplatelet therapy have a significant association with an increased risk of CSDH. This association, for patients under anticoagulant therapy, appears even stronger in those patients who develop a CSDH in the absence of a recent trauma.
在过去十年中，老年人中抗血小板/抗凝药物的使用呈上升趋势。本研究旨在评估抗凝/抗血小板治疗与慢性硬膜下血肿（CSDH）之间的关系。
这是一项单中心病例对照研究，纳入了 2001 年 1 月 1 日至 2010 年 12 月 31 日期间在我们学术性三级护理急诊就诊的 138786 名年龄大于 60 岁的患者。通过 ICD-9 编码 432.1 和 852.2x 回顾性分析确定了 345 例 CSDH（病例）患者。病例和对照按照性别、年龄（±5 岁）、入院年份和近期创伤进行 1:3 匹配。建立了条件逻辑模型。对有（842 例）和无（536 例）近期创伤的患者进行分层分析。
共纳入 345 例病例和 1035 例对照。抗凝药物和抗血小板药物均与 CSDH 风险增加相关，比值比（OR）分别为 2.46（95%可信区间 1.66-3.64）和 1.42（95%可信区间 1.07-1.89）。接受口服抗凝剂、ADP 拮抗剂或 COX 抑制剂的患者的 OR 分别为 2.70（95%可信区间 1.75-4.15）、1.90（95%可信区间 1.13-3.20）和 1.37（95%可信区间 0.99-1.90）。近期创伤史是抗凝药物与 CSDH 之间关联的效应修饰因子，有近期创伤史的患者 OR 为 1.71（95%可信区间 0.99-2.96），无近期创伤史的患者 OR 为 4.30（95%可信区间 2.23-8.32）。
抗凝和抗血小板治疗与 CSDH 风险增加有显著关联。对于接受抗凝治疗的患者，这种关联在无近期创伤但发生 CSDH 的患者中更为明显。
