Wada Masanori, Yamakami Iwao, Higuchi Yoshinori, Tanaka Mikio, Suda Sumio, Ono Junichi, Saeki Naokatsu
Department of Neurosurgery, Chiba Rehabilitation Center, 1-45-2 Hondacho, Midori-ku, Chiba-shi, Chiba 266-0005, Japan.
Department of Neurosurgery, Chiba Central Medical Center, 1835-1 Kasoricho, Wakaba-ku, Chiba 264-0017, Japan.
Clin Neurol Neurosurg. 2014 May;120:49-54. doi: 10.1016/j.clineuro.2014.02.007. Epub 2014 Feb 24.
The present study tested the hypothesis of whether antiplatelet agents (APA) induce chronic subdural hematoma (CSDH) recurrence via a platelet aggregation inhibitory effect.
We examined risk factors for CSDH recurrence, focusing on APA, in 719 consecutive patients who admitted to three tertiary hospitals and underwent burr-hole craniostomy and irrigation for CSDH. This was a multicenter, retrospective, observational study.
Age, sex, history of diabetes mellitus, hypertension, chronic renal failure, alcohol consumption habits, consciousness disturbance on admission, or preoperative CT density was not associated with recurrence. Subdural drainage was significantly associated with less recurrence. Preoperative oral APA administration was significantly associated with more recurrence. The recurrence rate of CSDH in non-APA group was 11% if surgery was performed on admission. However, if surgery was performed immediately after discontinuation of oral APA administration, the recurrence rate in APA group significantly increased to 32% (p value<0.0001; odds ratio, 3.77; 95% confidence interval, 1.72-8.28). The effect of APA on CSDH recurrence gradually diminished as the number of days until initial surgery, after stopping APA, increased.
Antiplatelet therapy significantly influences the recurrence of CSDH.
本研究检验了抗血小板药物（APA）是否通过抑制血小板聚集作用导致慢性硬膜下血肿（CSDH）复发这一假设。
我们在719例连续入住三家三级医院并接受CSDH钻孔引流及冲洗术的患者中，以APA为重点，研究了CSDH复发的危险因素。这是一项多中心、回顾性观察研究。
年龄、性别、糖尿病史、高血压、慢性肾衰竭、饮酒习惯、入院时意识障碍或术前CT密度与复发无关。硬膜下引流与复发减少显著相关。术前口服APA与复发增多显著相关。若入院时即行手术，非APA组CSDH复发率为11%。然而，若在停用口服APA后立即手术，APA组复发率显著增至32%（p值<0.0001；比值比，3.77；95%置信区间，1.72 - 8.28）。随着停用APA后至首次手术天数增加，APA对CSDH复发的影响逐渐减弱。
抗血小板治疗对CSDH复发有显著影响。
