Uccella Laura, Zoia Cesare, Bongetta Daniele, Gaetani Paolo, Martig Franz, Candrian Christian, Rosso Raffaele
Department of Surgery and Orthopaedics, Civico Hospital, Lugano, Switzerland.
Department of Neurosurgery, Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy.
World Neurosurg. 2018 Feb;110:e339-e345. doi: 10.1016/j.wneu.2017.10.173. Epub 2017 Nov 10.
Facing mild traumatic brain injury, clinicians must decide whether to perform a computed tomography (CT) scan to detect a potential intracranial hemorrhage. Many useful guidelines have been developed for the general population, but there is no general consensus about the best practice to adopt when dealing with patients on antiplatelet or anticoagulation drugs. The relatively recent introduction of new anticoagulants and second-generation antiplatelet drugs poses new challenges in this field. There are no data in the literature about the relative risk of intracranial bleeding in such categories.
We enrolled 2773 consecutive patients presenting at our emergency department with mild traumatic brain injury as chief complaint and evaluated the results of their head CT scans, stratifying their anticoagulation and/or antiplatelet drug regime.
Of these patients, 1608 matched the criteria for head CT scan and had a Glasgow Coma Scale (GCS) score of 15; 517 were on antiplatelet drugs, whereas 213 were on anticoagulants. The risk of developing intracranial bleeding was significantly higher for patients on antiplatelet drugs, whereas the risk of anticoagulated patients overlapped with that of the general population. The trend for second-generation drugs was of higher risk of bleeding only for antiplatelets.
Patients with a GCS score of 15 on long-term anticoagulation therapy seem to be at no higher risk for intracranial hemorrhage than are nonanticoagulated patients. On the contrary, patients with a GCS score of 15 on antiplatelet therapy seem to be more prone to developing intracranial bleeding than are the general population, with a trend to be more at risk when it comes to second-generation drugs.
面对轻度创伤性脑损伤，临床医生必须决定是否进行计算机断层扫描（CT）以检测潜在的颅内出血。针对普通人群已经制定了许多有用的指南，但在处理服用抗血小板或抗凝药物的患者时，对于最佳实践尚无普遍共识。相对较新的新型抗凝剂和第二代抗血小板药物的引入给该领域带来了新的挑战。文献中没有关于此类人群颅内出血相对风险的数据。
我们纳入了连续2773例以轻度创伤性脑损伤为主诉就诊于我们急诊科的患者，并评估了他们头部CT扫描的结果，对他们的抗凝和/或抗血小板药物治疗方案进行了分层。
在这些患者中，1608例符合头部CT扫描标准且格拉斯哥昏迷量表（GCS）评分为15分；517例服用抗血小板药物，而213例服用抗凝剂。服用抗血小板药物的患者发生颅内出血的风险显著更高，而服用抗凝剂的患者的风险与普通人群重叠。仅对于抗血小板药物，第二代药物的出血风险趋势更高。
长期接受抗凝治疗且GCS评分为15分的患者发生颅内出血的风险似乎并不高于未接受抗凝治疗的患者。相反，接受抗血小板治疗且GCS评分为15分的患者似乎比普通人群更容易发生颅内出血，对于第二代药物，其出血风险有增加趋势。
