AlKherayf Fahad, Xu Yan, Westwick Harrison, Moldovan Ioana Doina, Wells Philip S
Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada.
School of Medicine, Queen's University, Kingston, Canada; Division of Hematology, Department of Medicine, Ottawa, Canada.
Clin Neurol Neurosurg. 2017 Mar;154:23-27. doi: 10.1016/j.clineuro.2017.01.006. Epub 2017 Jan 16.
While oral anticoagulation (OAC) is universally indicated for patients with mechanical heart valves (MHVs), OAC resumption following anticoagulant-associated intracerebral hemorrhage (ICH) is an area of uncertainty. We sought to determine the practice preferences of North American neurosurgeons and thrombosis experts on optimal timing of OAC re-initiation.
A cross-sectional survey was disseminated to North American members of the American Association of Neurological Surgeons and the International Society for Thrombosis and Haemostasis. Demographic factors, as well as a clinical scenario with 14 modifiable clinical risk factors were included in the survey.
504 physicians completed our survey (response rate 34.3%). Majority of participants were affiliated with academic centres, and managed≤10 ICH patients with MHV per year. There was wide distribution in response in optimal timing for OAC resumption following an ICH: 59% and 60% preferred to re-start OAC between 3 and 14 days following the hemorrhagic event (median of 6-7 days). Smaller hemorrhages (<30cm). CHADS score ≥2, concomitant venous thromboembolism, mitral valve prosthesis, caged-ball valves and multiple valves prompted earlier OAC resumption.
Wide variation in the current practice of neurosurgeons and thrombosis specialists exist when they encounter patients with ICH and MHV, though decisions were influenced by patient- and valve-related factors. As our observed variation likely reflects the immense gap in current evidence, prospective randomized trials in this population are therefore urgently needed.
虽然口服抗凝药（OAC）普遍适用于机械心脏瓣膜（MHV）患者，但抗凝相关脑出血（ICH）后重新开始使用OAC是一个存在不确定性的领域。我们试图确定北美神经外科医生和血栓形成专家在OAC重新启动最佳时机方面的实践偏好。
向美国神经外科医生协会和国际血栓与止血学会的北美成员进行了横断面调查。调查中纳入了人口统计学因素以及包含14个可改变临床风险因素的临床情景。
504名医生完成了我们的调查（回复率34.3%）。大多数参与者隶属于学术中心，每年管理≤10例患有MHV的ICH患者。对于ICH后OAC重新启动的最佳时机，回复分布广泛：59%和60%的人倾向于在出血事件发生后的3至14天之间重新开始使用OAC（中位数为6 - 7天）。较小的出血（<30cm）、CHADS评分≥2、合并静脉血栓栓塞、二尖瓣假体、笼球瓣和多个瓣膜促使更早重新开始使用OAC。
神经外科医生和血栓形成专家在遇到患有ICH和MHV的患者时，目前的实践存在很大差异，尽管决策受到患者和瓣膜相关因素的影响。由于我们观察到的差异可能反映了当前证据的巨大差距，因此迫切需要在该人群中进行前瞻性随机试验。
