Dziedzic Tomasz Andrzej, Kunert Przemysław, Marchel Andrzej
Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
J Korean Neurosurg Soc. 2017 Mar;60(2):232-238. doi: 10.3340/jkns.2015.1212.005. Epub 2017 Mar 1.
An apparent increase of use of drugs affecting hemostasis in our neurosurgical department since the 1990s has encouraged us to investigate whether these drugs influence the clinical course and results of surgery for chronic subdural hematoma (CSDH).
This retrospective analysis included 178 patients admitted for CSDH from 2007 to 2011 who were divided into two groups: on drugs affecting hemostasis (40; 22%) and no bleeding disorders (138; 78%). Medications in the first group included oral anticoagulants (33; 82.5%), antiplatelets (5; 12.5%) and low molecular weight heparins (2; 5%).
The patients on drugs affecting hemostasis were older (74.3±7.4 vs. 68.4±14.8; -value 0.01) and the group without bleeding disorders had more head trauma history (61% vs. 38%, -value 0.01). The groups did not differ in bilateral hematoma rates (25% vs. 20%, -value=NS). At diagnosis, mean hematoma thickness was lower in patients on drugs affecting hemostasis (18.7±7.4 mm vs. 21.9±7.9 mm, -value<0.01). Average stay of hospital was 1 day longer in patients on drugs affecting hemostasis (11.7±4.1 vs.10.9±5.3, -value=NS) and was related to the necessity of bleeding disorder reversal. Mean neurological status at presentation was similar between the groups (-value=NS) as was the likelihood of hematoma recurrence (-value=NS). Glasgow Outcome Scale results were comparable.
Patients on drugs affecting hemostasis are less often aware of a head trauma history, possibly suggesting a higher CSDH risk after minor trauma in this group. In these patients, smaller hematomas are symptomatic, probably due to faster hematoma formation. Drugs affecting hemostasis do not affect treatment results.
自20世纪90年代以来，我们神经外科使用影响止血的药物明显增加，这促使我们研究这些药物是否会影响慢性硬膜下血肿（CSDH）的临床病程及手术结果。
这项回顾性分析纳入了2007年至2011年因CSDH入院的178例患者，将其分为两组：使用影响止血药物组（40例；22%）和无出血性疾病组（138例；78%）。第一组的药物包括口服抗凝剂（33例；82.5%）、抗血小板药物（5例；12.5%）和低分子量肝素（2例；5%）。
使用影响止血药物的患者年龄较大（74.3±7.4岁 vs. 68.4±14.8岁；P值0.01），无出血性疾病组有更多头部外伤史（61% vs. 38%，P值0.01）。两组双侧血肿发生率无差异（25% vs. 20%，P值=无显著性差异）。诊断时，使用影响止血药物的患者平均血肿厚度较低（18.7±7.4mm vs. 21.9±7.9mm，P值<0.01）。使用影响止血药物的患者平均住院时间长1天（11.7±4.1天 vs.10.9±5.3天，P值=无显著性差异），这与逆转出血性疾病的必要性有关。两组患者入院时的平均神经状态相似（P值=无显著性差异），血肿复发的可能性也相似（P值=无显著性差异）。格拉斯哥预后量表结果具有可比性。
使用影响止血药物的患者较少意识到有头部外伤史，这可能表明该组患者在轻微创伤后发生CSDH的风险较高。在这些患者中，较小的血肿有症状，可能是由于血肿形成较快。影响止血的药物不影响治疗结果。
