伤前抗凝及抗血小板药物对老年严重创伤患者失血的影响。

Effect of pre-injury anticoagulant and antiplatelet agents on blood loss in elderly patients with severe trauma.

作者信息

Ohmori Takao, Kitamura Taisuke, Onishi Hirokazu, Ishihara Junko, Nojima Tsuyoshi, Yamamoto Koutarou

机构信息

Emergency and Critical Care Center Kochi Health Sciences Center Kochi Japan.

出版信息

Acute Med Surg. 2015 Aug 27;3(2):114-119. doi: 10.1002/ams2.152. eCollection 2016 Apr.

DOI:10.1002/ams2.152

PMID:29123762

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5667378/

Abstract

AIM

It has been widely reported that pre-injury use of anticoagulant and antiplatelet agents can affect traumatic brain injury and the associated risk of mortality, however, the effect of these agents on non-head injury site-related blood loss remains unclear. Therefore, we investigated the effects of pre-injury anticoagulant and antiplatelet agents on the transfusion amount and the need for massive transfusion in elderly patients with severe trauma.

METHODS

We retrospectively reviewed a cohort of elderly patients with severe trauma (age, ≥65 years; Injury Severity Score, ≥16) between September 2006 and March 2014. The selected patients were subsequently divided into patients who were: only taking warfarin, aspirin, or clopidogrel; taking various combinations of these agents; and a control group who were not taking any of these agents.

RESULTS

During the study period, 67 patients (20%) were taking anticoagulant and antiplatelet agents and 272 patients were included in the control group. Among these patients, 10 were receiving only warfarin, 28 were receiving only aspirin, 14 were receiving only clopidogrel, and 13 were receiving various combinations of these medications. The amount of red cell concentrate and need for massive transfusions were only significantly increased in the warfarin group ( < 0.05). Furthermore, the warfarin group had a significantly higher risk of needing a massive transfusion with multivariate logistic regression analysis (odds ratio, 5.03; 95% confidence interval, 1.25-20.20; < 0.05).

CONCLUSION

Patients who were receiving only warfarin before their injury had an increased risk of bleeding due to non-head injuries.

摘要

目的

已有广泛报道称，伤前使用抗凝剂和抗血小板药物会影响创伤性脑损伤及相关死亡风险，然而，这些药物对非头部损伤部位出血的影响仍不明确。因此，我们调查了伤前抗凝剂和抗血小板药物对老年严重创伤患者输血量及大量输血需求的影响。

方法

我们回顾性分析了2006年9月至2014年3月期间一组老年严重创伤患者（年龄≥65岁；损伤严重程度评分≥16）。随后将选定患者分为以下几类：仅服用华法林、阿司匹林或氯吡格雷的患者；服用这些药物各种组合的患者；以及未服用任何这些药物的对照组。

结果

在研究期间，67例患者（20%）服用抗凝剂和抗血小板药物，272例患者纳入对照组。在这些患者中，10例仅接受华法林治疗，28例仅接受阿司匹林治疗，14例仅接受氯吡格雷治疗，13例接受这些药物的各种组合治疗。红细胞浓缩液用量和大量输血需求仅在华法林组显著增加（<0.05）。此外，多因素逻辑回归分析显示，华法林组大量输血风险显著更高（比值比，5.03；95%置信区间，1.25 - 20.20；<0.05）。