创伤后直接作用口服抗凝剂致迟发性颅内出血的风险：一项双中心研究。
The risk of delayed intracranial hemorrhage with direct acting oral anticoagulants after trauma: A two-center study.
机构信息
Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Surgery, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California, San Diego, CA, USA.
出版信息
Am J Surg. 2019 Jun;217(6):1051-1054. doi: 10.1016/j.amjsurg.2018.10.016. Epub 2018 Oct 14.
BACKGROUND
The aim of this study was to characterize the risk of a delayed intracranial hemorrhage (ICH) in trauma patients on direct-acting oral anticoagulants (DOACs).
METHODS
Patients on DOACs admitted to two Level I Trauma Centers between 2014 and 2017 were reviewed. Only patients with a negative admission CT brain were included. The primary outcome was a delayed ICH.
RESULTS
Overall, 249 patients were included. The median age was 81 years with 82% undergoing a repeat CT. Three patients developed a delayed ICH (1.2%). One developed an ICH after receiving tissue plasminogen activator for a cerebrovascular accident after two negative CTs. Excluding this patient, the incidence dropped to 0.8%. None required neurosurgical intervention.
CONCLUSION
For patients at risk for a TBI who are on DOACs, repeat cross-sectional imaging of the brain when the initial imaging is negative is not necessary. A period of clinical observation may be warranted.
背景
本研究旨在描述创伤患者在直接口服抗凝药物（DOAC）治疗下发生迟发性颅内出血（ICH）的风险特征。
方法
回顾了 2014 年至 2017 年间在两家一级创伤中心接受 DOAC 治疗的患者。仅纳入初始入院 CT 脑检查结果为阴性的患者。主要结局为迟发性 ICH。
结果
共纳入 249 例患者。中位年龄为 81 岁，82%的患者行重复 CT 检查。3 例患者发生迟发性 ICH（1.2%）。1 例患者在两次阴性 CT 检查后因脑血管意外接受组织型纤溶酶原激活剂治疗后发生 ICH。排除该患者后，发病率降至 0.8%。均无需神经外科干预。
结论
对于存在 TBI 风险且正在接受 DOAC 治疗的患者，初始影像学检查为阴性时，无需再次进行脑部横断面成像。可能需要进行一段时间的临床观察。
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