Joseph Bellal, Sadoun Moutamn, Aziz Hassan, Tang Andrew, Wynne Julie L, Pandit Viraj, Kulvatunyou Narong, O'Keeffe Terence, Friese Randall S, Rhee Peter
Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona, USA.
Am Surg. 2014 Jan;80(1):43-7.
Anticoagulation agents are proven risk factors for intracranial hemorrhage (ICH) in traumatic brain injury (TBI). The aim of our study is to describe the epidemiology of prehospital coumadin, aspirin, and Plavix (CAP) patients with ICH and evaluate the use of repeat head computed tomography (CT) in this group. We performed a retrospective study from our trauma registry. All patients with intracranial hemorrhage on initial CT with prehospital CAP therapy were included. Demographics, CT scan findings, number of repeat CT scans, progressive findings, and neurosurgical intervention were abstracted. A comparison between prehospital CAP and no-CAP patients was done using χ(2) and Mann-Whitney U test. A total of 1606 patients with blunt TBI charts were reviewed of whom 508 patients had intracranial bleeding on initial CT scan and 72 were on prehospital CAP therapy. CAP patients were older (P < 0.001), had higher Injury Severity Score and head Abbreviated Injury Scores on admission (P < 0.001), were more likely to present with an abnormal neurologic examination (P = 0.004), and had higher hospital and intensive care unit lengths of stay (P < 0.005). Eighty-four per cent of patients were on antiplatelet therapy and 27 per cent were on warfarin. The CAP patients have a threefold increase in the rate of worsening repeat head CT (26 vs 9%, P < 0.05). Prehospital CAP therapy is high risk for progression of bleeding on repeat head CT. Routine repeat head CT remains an important component in this patient population and can provide useful information.
抗凝剂已被证实是创伤性脑损伤（TBI）患者发生颅内出血（ICH）的风险因素。我们研究的目的是描述院前服用香豆素、阿司匹林和波立维（CAP）并发生ICH患者的流行病学特征，并评估该组患者重复头颅计算机断层扫描（CT）的应用情况。我们从创伤登记处进行了一项回顾性研究。纳入所有初始CT显示颅内出血且接受院前CAP治疗的患者。提取人口统计学资料、CT扫描结果、重复CT扫描次数、病情进展情况以及神经外科干预措施。采用χ²检验和曼-惠特尼U检验对院前CAP治疗患者和未接受CAP治疗的患者进行比较。共查阅了1606例钝性TBI患者的病历，其中508例患者初始CT扫描显示颅内出血，72例接受院前CAP治疗。CAP治疗组患者年龄较大（P < 0.001），入院时损伤严重程度评分和头部简明损伤评分较高（P < 0.001），更有可能出现神经系统检查异常（P = 0.004），住院时间和重症监护病房住院时间更长（P < 0.005）。84%的患者接受抗血小板治疗，27%的患者接受华法林治疗。CAP治疗组患者重复头颅CT显示病情恶化的发生率增加了两倍（26%对9%，P < 0.05）。院前CAP治疗会使重复头颅CT上出血进展的风险升高。常规重复头颅CT仍然是该患者群体的重要组成部分，并且可以提供有用信息。
