From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.
J Trauma Acute Care Surg. 2014 Mar;76(3):817-20. doi: 10.1097/TA.0b013e3182aafcf0.
Patients receiving antiplatelet medications are considered to be at an increased risk for traumatic intracranial hemorrhage after blunt head trauma. However, most studies have categorized all antiplatelet drugs into one category. The aim of our study was to evaluate clinical outcomes and the requirement of a repeat head computed tomography (RHCT) in patients on preinjury clopidogrel therapy.
Patients with traumatic brain injury with intracranial hemorrhage on initial head CT were prospectively enrolled. Patients on preinjury clopidogrel were matched with patients exclusive of antiplatelet and anticoagulation therapy using a propensity score in a 1:1 ratio for age, Glasgow Coma Scale (GCS), head Abbreviated Injury Scale (h-AIS), Injury Severity Score (ISS), neurologic examination, and platelet transfusion. Outcome measures were progression on RHCT scan and need for neurosurgical intervention.
A total of 142 patients with intracranial hemorrhage on initial head CT scan (clopidogrel, 71; no clopidogrel, 71) were enrolled. The mean (SD) age was 70.5 (15.1) years, 66% were male, median GCS score was 14 (range, 3-15), and median h-AIS (ISS) was 3 (range, 2-5). The mean (SD) platelet count was 210 (101), and 61% (n = 86) of the patients received platelet transfusion. Patients on preinjury clopidogrel were more likely to have progression on RHCT (odds ratio [OR], 5.1; 95% confidence interval [CI], 3.1-7.1) and RHCT as a result of clinical deterioration (OR, 2.1; 95% CI, 1.8-3.5). The overall rate of neurosurgical intervention was 4.2% (n = 6). Patients on clopidogrel therapy were more likely to require a neurosurgical intervention (OR, 1.8; 95% CI, 1.4-3.1).
Preinjury clopidogrel therapy is associated with progression of initial insult on RHCT scan and need for neurosurgical intervention. Preinjury clopidogrel therapy as an independent variable should warrant the need for a routine RHCT scan in patients with traumatic brain injury.
Prognostic study, level I; therapeutic study, level II.
接受抗血小板药物治疗的患者在遭受钝性头部创伤后，被认为有发生创伤性颅内出血的风险增加。然而，大多数研究将所有抗血小板药物归入一类。我们的研究旨在评估接受术前氯吡格雷治疗的患者的临床结果和重复头部 CT（RHCT）的需求。
前瞻性纳入初始头部 CT 显示颅内出血的创伤性脑损伤患者。使用倾向评分以 1:1 的比例为年龄、格拉斯哥昏迷量表（GCS）、头部损伤严重程度评分（h-AIS）、损伤严重程度评分（ISS）、神经检查和血小板输注匹配术前接受氯吡格雷治疗的患者和单独接受抗血小板和抗凝治疗的患者。主要结局是 RHCT 扫描进展和需要神经外科干预。
共纳入 142 例初始头部 CT 扫描显示颅内出血的患者（氯吡格雷组 71 例，无氯吡格雷组 71 例）。平均（SD）年龄为 70.5（15.1）岁，66%为男性，中位 GCS 评分为 14（范围 3-15），中位 h-AIS（ISS）为 3（范围 2-5）。血小板计数的平均值（SD）为 210（101），61%（n=86）的患者接受了血小板输注。术前使用氯吡格雷的患者更有可能出现 RHCT 扫描进展（比值比[OR]，5.1；95%置信区间[CI]，3.1-7.1）和 RHCT 扫描由于临床恶化（OR，2.1；95% CI，1.8-3.5）。总体神经外科干预率为 4.2%（n=6）。接受氯吡格雷治疗的患者更有可能需要神经外科干预（OR，1.8；95% CI，1.4-3.1）。
术前氯吡格雷治疗与 RHCT 扫描初始损伤进展和需要神经外科干预相关。术前氯吡格雷治疗作为一个独立变量，应确保创伤性脑损伤患者需要常规进行 RHCT 扫描。
预后研究，I 级；治疗研究，II 级。
