Yang Na Rae, Kim Sang Jin, Seo Eui Kyo
Department of Neurosurgery, Ewha Womans University School of Medicine, Mokdong Hospital, 911-1 Mok-dong, Yangcheon-gu, Seoul, 158-710, Korea.
Acta Neurochir (Wien). 2014 Jul;156(7):1319-25. doi: 10.1007/s00701-014-2080-2. Epub 2014 Apr 27.
Problems that the risk of using antiplatelet/anticoagulant may overwhelm its benefits have been raised. We analyzed patients with spontaneous intracerebral hemorrhage who had received antiplatelet/anticoagulant therapy.
A consecutive series of patients with spontaneous intracerebral hemorrhage who underwent brain computed tomographic (CT) scans within 48 h from attack. We analyzed the clinical manifestations and radiologic findings of the patients according to antiplatelet/anticoagulant therapy: Antiplatelet group, Anticoagulant group, and None group.
A total of 338 patients were included in the study. The initial volume of hematoma was 46.8 ml in the Anticoagulant group, and 24.1 ml in the None group. There were significant differences among the groups in terms of intraventricular hemorrhage (Antiplatelet group: 45.6 %, Anticoagulant group: 20 %, None: 26.4 %, p = 0.008), and the proportion of hydrocephalus in the Antiplatelet group was higher than in another group (p = 0.017). Also, herniation and expansion of spontaneous intracerebral hemorrhage had significant differences among the groups. The prognoses of the None group were the best among the groups. There was also significant difference in the mortality among the groups.
In comparison with the None group, the spontaneous intracerebral hemorrhages of the Antiplatelet/Anticoagulant group were a little more extensive and they had more intraventricular hemorrhage, hydrocephalus, herniation, and expansion of spontaneous intracerebral hemorrhage that would come to poor prognosis. Therefore, antiplatelets and anticoagulants should be used under strict indications.
使用抗血小板/抗凝药物时风险可能超过其益处的问题已被提出。我们分析了接受抗血小板/抗凝治疗的自发性脑出血患者。
对一系列在发病后48小时内接受脑部计算机断层扫描（CT）的自发性脑出血患者进行连续研究。我们根据抗血小板/抗凝治疗情况分析患者的临床表现和影像学结果：抗血小板组、抗凝组和未治疗组。
本研究共纳入338例患者。抗凝组血肿初始体积为46.8毫升，未治疗组为24.1毫升。各组在脑室出血方面存在显著差异（抗血小板组：45.6%，抗凝组：20%，未治疗组：26.4%，p = 0.008），抗血小板组脑积水比例高于其他组（p = 0.017）。此外，各组间自发性脑出血的脑疝形成和血肿扩大情况也存在显著差异。未治疗组的预后在各组中最佳。各组间死亡率也存在显著差异。
与未治疗组相比，抗血小板/抗凝组的自发性脑出血范围更广，脑室出血、脑积水、脑疝形成及血肿扩大更多，预后较差。因此，抗血小板和抗凝药物应在严格指征下使用。
