Nathan Santhosh, Goodarzi Zahra, Jette Nathalie, Gallagher Clare, Holroyd-Leduc Jayna
From the Cumming School of Medicine (S.N.), Departments of Medicine (Z.G., J.H.-L.), Community Health Sciences (N.J., J.H.-L.), and Clinical Neurosciences (N.J., C.G.), Hotchkiss Brain Institute (N.J., C.G., J.H.-L.), and O'Brien Institute for Public Health (N.J., J.H.-L.), University of Calgary, Canada.
Neurology. 2017 May 16;88(20):1889-1893. doi: 10.1212/WNL.0000000000003918. Epub 2017 Apr 14.
To address whether to restart older patients on anticoagulants or antiplatelet agents in the setting of a chronic subdural hematoma (cSDH).
This is an update of a previous review (searched until July 2012). Medline, EMBASE, ISI Web of Knowledge, Google Scholar, PLOS, and the Cochrane Register for Systematic Reviews databases were searched from January 2012 to December 2016. Studies included older adults (those over 65 years) experiencing traumatic subdural hematoma or cSDH who were on anticoagulation or antiplatelet agents.
Seven studies were included (mean age 72 years). Four out of 7 studies provided combined data on anticoagulants or antiplatelet use. Only one study found anticoagulant or antiplatelet agent use to be a significant factor for cSDH rebleeding. Two studies considered anticoagulant use only and both reported similar increased odds of rebleeding (odds ratio [OR] 1.75, 95% confidence interval [CI] 0.18-16.86; OR 2.7 95% CI 1.42-6.96). Antiplatelets were not found to be associated with rebleeding. Ideal timing to resume anticoagulants or antiplatelets was unclear.
Anticoagulant medication was associated with increased rebleeding risk in older adults with cSDH. However, antiplatelet medication was not associated with increased risk of rebleeding.
探讨在慢性硬膜下血肿（cSDH）情况下，老年患者是否应重新开始使用抗凝剂或抗血小板药物。
这是对先前综述（检索至2012年7月）的更新。检索了2012年1月至2016年12月期间的Medline、EMBASE、ISI Web of Knowledge、谷歌学术、PLOS和Cochrane系统评价注册数据库。纳入的研究对象为年龄较大的成年人（65岁以上），他们患有创伤性硬膜下血肿或cSDH，且正在使用抗凝剂或抗血小板药物。
纳入7项研究（平均年龄72岁）。7项研究中有4项提供了关于抗凝剂或抗血小板药物使用的综合数据。只有1项研究发现抗凝剂或抗血小板药物的使用是cSDH再出血的一个重要因素。2项研究仅考虑了抗凝剂的使用，两者均报告再出血几率有类似增加（比值比[OR]1.75，95%置信区间[CI]0.18 - 16.86；OR 2.7，95%CI 1.42 - 6.96）。未发现抗血小板药物与再出血有关。恢复使用抗凝剂或抗血小板药物的理想时机尚不清楚。
抗凝药物与患有cSDH的老年人再出血风险增加有关。然而，抗血小板药物与再出血风险增加无关。
