Lee Alex T, Gagnidze Arni, Pan Sharon R, Sookplung Pimwan, Nair Bala, Newman Shu-Fang, Ben-Ari Alon, Zaky Ahmed, Cain Kevin, Vavilala Monica S, Rozet Irene
From the *Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; †Anesthesiology Division, VA Puget Sound Health System, Seattle, Washington; ‡College of Arts and Sciences, University of Washington, Seattle, Washington; §Department of Anesthesiology, Prasat Neurological Institute, Bangkok, Thailand; ‖Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, Washington; ¶Department of Anesthesiology, University of Alabama, Birmingham, Alabama; #Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington; and **Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington.
Anesth Analg. 2017 Aug;125(2):514-520. doi: 10.1213/ANE.0000000000002053.
Antiplatelet medications are usually discontinued before elective neurosurgery, but this is not an option for emergent neurosurgery. We performed a retrospective cohort study to examine whether preoperative aspirin use was associated with worse outcomes after emergency neurosurgery in elderly patients.
We analyzed all cases of emergency neurosurgical procedures for traumatic intracranial hemorrhage from 2008 to 2012 at a level 1 trauma center. Demographics, comorbidities, and outcomes were compared for patients ≥65 years by preoperative aspirin exposure. Exclusion criteria were: (1) polytrauma, (2) concomitant use of other preoperative anticoagulants or antiplatelet agents, (3) surgical indication other than subdural, extradural, or intraparenchymal hemorrhage, and (4) repeat neurosurgical procedures within a single admission. Estimated intraoperative blood loss, postprocedural intracranial bleeding requiring reoperation, death in hospital, intensive care unit, and hospital lengths of stay and perioperative blood product transfusion from 48 hours before 48 hours after surgery were the study outcomes. We also examined whether platelet transfusion had an impact on outcomes for patients on aspirin.
The cohort included 171 patients. Patients receiving preoperative aspirin (n = 87, 95% taking 81 mg/day) were the same age as patients not receiving aspirin (n = 84; 78.3 ± 7.8 vs 75.9 ± 7.9 years, P > .05), had slightly higher admission Glasgow Coma Scale scores (12.8 ± 3.4 vs 11.4 ± 4, P = .02) and tended to have more coronary artery disease (P< .05). Adjusted for Glasgow Coma Scale and coronary artery disease, patients receiving preoperative aspirin had a higher odds of perioperative platelet transfusion (adjusted odds ratio 9.89, 95% confidence interval, 4.24-26.25). There were no other differences in outcomes between the 2 groups. Preoperative or intraoperative platelet transfusion was not associated with better outcomes among aspirin patients.
In patients age ≥65 years undergoing emergency neurosurgery for traumatic intracranial hemorrhage, preoperative low-dose aspirin treatment was not associated with increased perioperative bleeding, hospital lengths of stay, or in-hospital mortality.
抗血小板药物通常在择期神经外科手术前停用，但对于急诊神经外科手术而言并非如此。我们进行了一项回顾性队列研究，以检验老年患者在急诊神经外科手术后，术前使用阿司匹林是否与更差的预后相关。
我们分析了2008年至2012年在一家一级创伤中心进行的所有外伤性颅内出血急诊神经外科手术病例。根据术前是否接触阿司匹林，对年龄≥65岁的患者的人口统计学、合并症和预后进行比较。排除标准为：（1）多发伤；（2）术前同时使用其他抗凝剂或抗血小板药物；（3）除硬膜下、硬膜外或脑实质内出血以外的手术指征；（4）单次住院期间重复进行神经外科手术。研究结局包括估计术中失血量、术后需要再次手术的颅内出血、住院死亡、重症监护病房情况、住院时间以及手术前48小时至手术后48小时的围手术期血液制品输注情况。我们还研究了血小板输注对服用阿司匹林患者预后的影响。
该队列包括171例患者。接受术前阿司匹林治疗的患者（n = 87，95%服用81毫克/天）与未接受阿司匹林治疗的患者年龄相同（n = 84；分别为78.3±7.8岁和75.9±7.9岁，P>.05），入院时格拉斯哥昏迷量表评分略高（分别为12.8±3.4和11.4±4，P = .02），且往往患有更多的冠状动脉疾病（P<.05）。在对格拉斯哥昏迷量表和冠状动脉疾病进行校正后，接受术前阿司匹林治疗的患者围手术期血小板输注的几率更高（校正比值比9.89，95%置信区间，4.24 - 26.25）。两组在其他预后方面没有差异。术前或术中血小板输注与服用阿司匹林患者的更好预后无关。
在年龄≥65岁的外伤性颅内出血急诊神经外科手术患者中，术前低剂量阿司匹林治疗与围手术期出血增加、住院时间延长或住院死亡率升高无关。
