Nakamizo Akira, Michiwaki Yuhei, Kawano Yousuke, Amano Toshiyuki, Matsuo Satoshi, Fujioka Yutaka, Tsumoto Tomoyuki, Yasaka Masahiro, Okada Yasushi
Department of Neurosurgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Japan.
Department of Neurosurgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Japan.
Clin Neurol Neurosurg. 2017 Oct;161:93-97. doi: 10.1016/j.clineuro.2017.08.016. Epub 2017 Aug 30.
Patients receiving antithrombotic treatment occasionally undergo craniotomy. We aimed to explore the impact of perioperative use of antithrombotic agents on the occurrence of surgical complications and clinical outcomes in patients with unruptured intracranial aneurysm (UIA).
We retrospectively analyzed 401 consecutive patients who had undergone craniotomy for UIA at our institution between January 2006 and December 2016. Patients were divided into two groups: those who received oral antiplatelet and/or anticoagulant agents during the perioperative period (antithrombotic treatment group, n=45); and those who did not (no antithrombotic treatment group, n=356). In the antithrombotic treatment group, 40 patients received antiplatelet alone, 2 received anticoagulant alone, and 3 received antiplatelet plus anticoagulant.
The two groups showed no significant differences in mortality, morbidity, or occurrence of symptomatic brain infarction, but intracranial hemorrhage was more frequent in the antithrombotic treatment group than in the no antithrombotic treatment group (p=0.0187). Multivariate analysis revealed posterior location of the aneurysm (odds ratio (OR), 8.10; 95% confidence interval (CI), 2.77-23.68; p=0.0001) and surgical procedure (OR, 5.48; 95%CI, 1.68-17.86; p=0.0048) as significantly correlated with severe morbidity, and intracranial hemorrhage as correlated significantly with antithrombotic treatment (OR, 3.83; 95%CI, 1.36-10.76; p=0.0110).
This study provides important information about the occurrence of intracranial hemorrhage and clinical outcomes in patients undergoing antithrombotic treatment during the perioperative period of craniotomy for UIA.
接受抗血栓治疗的患者偶尔需要进行开颅手术。我们旨在探讨围手术期使用抗血栓药物对未破裂颅内动脉瘤（UIA）患者手术并发症发生情况及临床结局的影响。
我们回顾性分析了2006年1月至2016年12月期间在我院因UIA接受开颅手术的401例连续患者。患者分为两组：围手术期接受口服抗血小板和/或抗凝药物治疗的患者（抗血栓治疗组，n = 45）；未接受治疗的患者（非抗血栓治疗组，n = 356）。在抗血栓治疗组中，40例患者仅接受抗血小板治疗，2例仅接受抗凝治疗，3例接受抗血小板加抗凝治疗。
两组在死亡率、发病率或症状性脑梗死发生率方面无显著差异，但抗血栓治疗组颅内出血的发生率高于非抗血栓治疗组（p = 0.0187）。多因素分析显示，动脉瘤的后位（优势比（OR），8.10；95%置信区间（CI），2.77 - 23.68；p = 0.0001）和手术操作（OR，5.48；95%CI，1.68 - 17.86；p = 0.0048）与严重发病率显著相关，颅内出血与抗血栓治疗显著相关（OR，3.83；95%CI，1.36 - 10.76；p = 0.0110）。
本研究提供了关于UIA开颅手术围手术期接受抗血栓治疗患者颅内出血发生情况及临床结局的重要信息。
