Busch M A, Hoffmann O, Einhäupl K M, Masuhr F
Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Eur J Neurol. 2016 Sep;23(9):1387-92. doi: 10.1111/ene.13064. Epub 2016 Jun 14.
The influence of temporal patterns of intracerebral haemorrhage (ICH) on the outcome of heparin-treated patients with cerebral venous sinus thrombosis (CVST) has not been examined systematically.
Temporal patterns of ICH and their influence on survival without disability (modified Rankin Scale score ≤1 point) at hospital discharge were examined in 141 consecutive hospital-admitted patients with acute CVST who were treated with intravenous unfractionated heparin.
Of all 141 patients (median age 40 years; 73% women), 59 (42%) had ICH at the time of diagnosis (early ICH). Of these, seven (12%) subsequently had extension of ICH and 13 (22%) had additional ICHs at other locations (delayed ICH). Of 82 patients without early ICH, nine (11%) later had delayed ICH. After a median hospital stay of 26 days, 107 patients (76%) were discharged without disability. Patients with early ICH were less likely to survive without disability until discharge than those without early ICH [63% vs. 85%; risk ratio (RR) 0.73; P = 0.005]. The association was attenuated after adjusting for age, sex and impaired consciousness on admission (RR 0.83; P = 0.03). Taking temporal patterns of ICH into account, early ICH with subsequent complication (extension or delayed ICH) had a larger influence on survival without disability (RR 0.57; 95% confidence interval 0.35-0.95) than early ICH without complications (RR 0.78; 95% confidence interval 0.67-0.91).
Heparin-treated CVST patients were less likely to survive without disability when ICH was present on admission. This association may largely be driven by subsequent extension of haemorrhage or additionally occurring delayed haemorrhage.
尚未系统研究脑出血（ICH）的时间模式对接受肝素治疗的脑静脉窦血栓形成（CVST）患者预后的影响。
在141例连续入院并接受静脉普通肝素治疗的急性CVST患者中，研究ICH的时间模式及其对出院时无残疾生存（改良Rankin量表评分≤1分）的影响。
在所有141例患者（中位年龄40岁；73%为女性）中，59例（42%）在诊断时即有ICH（早期ICH）。其中，7例（12%）随后出现ICH扩展，13例（22%）在其他部位出现额外的ICH（延迟ICH）。在82例无早期ICH的患者中，9例（11%）后来出现延迟ICH。中位住院26天后，107例患者（76%）出院时无残疾。有早期ICH的患者出院时无残疾生存的可能性低于无早期ICH的患者[63%对85%；风险比（RR）0.73；P = 0.005]。在调整年龄、性别和入院时意识障碍后，这种关联减弱（RR 0.83；P = 0.03）。考虑到ICH的时间模式，有后续并发症（扩展或延迟ICH）的早期ICH对无残疾生存的影响（RR 0.57；95%置信区间0.35 - 0.95）大于无并发症的早期ICH（RR 0.78；95%置信区间0.67 - 0.91）。
入院时存在ICH的肝素治疗CVST患者无残疾生存的可能性较小。这种关联可能主要由随后的出血扩展或额外发生的延迟出血所驱动。
