抗血栓药物治疗的患者轻微创伤性脑损伤后的颅内出血风险。
Intracranial bleeding risk after minor traumatic brain injury in patients on antithrombotic drugs.
机构信息
Department of Medicine and Surgery, University of Insubria, Varese, Italy; Emergency Department, Ospedale di Circolo, Varese, Italy.
Department of Medicine and Surgery, University of Insubria, Varese, Italy; Emergency Department, Ospedale di Circolo, Varese, Italy.
出版信息
Thromb Res. 2019 Feb;174:113-120. doi: 10.1016/j.thromres.2018.12.015. Epub 2018 Dec 12.
BACKGROUND
Intracranial haemorrhage (ICH) risk after minor traumatic brain injury (mTBI) in patients on antithrombotic treatment is unclear. We compared ICH rates in mTBI patients on single, double and no antithrombotic therapy. Antithrombotic drugs encompassed vitamin K antagonists (VKAs), direct oral anticoagulants (DOACs) and antiplatelets. Secondary aim was to identify potential predictors of ICH.
METHODS
We retrospectively analysed consecutive adults referred to our emergency department for mTBI. All clinical information was retrieved by patients' charts review. Patients were divided in 5 groups: 1) no antithrombotic users, 2) antiplatelet users, 3) vitamin K antagonist users, 4) direct oral anticoagulants users, and 5) double antithrombotic users.
RESULTS
A total of 1846 patients were enrolled, mean age 71 years (IQR 46-83); 1222 (66.2%) were in group 1, 407 (22.0%) in group 2, 120 (6.5%) in group 3, 51 (2.7%) in group 4 and 46 (2.5%) in group 5. At entry, 1387 (75.1%) patients underwent brain CT, 787 (64.4%) in group 1, 387 (95.1%) in group 2, 119 (99.2%) in group 3 and 51 (100%) in group 4 and 43 (93.5%) in group 5. ICH was documented in 36 patients (4.6%; CI 95%: 3.2-6.3) in group 1, 22 (5.9%; CI 95%: 3.6-8.5) in group 2, 5 (4.2%; CI 95%: 1.4-9.5) in group 3, 2 (3.9%; CI 95%: 0.5-13.5) in group 4 and 3 (7.0%; CI 95%: 1.5-19.1) in group 5 (p-value for across groups comparison = 0.86). At multivariable analysis GCS < 15 (OR 7.95 CI 95%: 3.12-20.28), post-traumatic amnesia (OR 6.49; CI 95%:3.57-11.82), vomiting (OR 4.45 CI 95%:1.47-13.50), clinical signs of cranial fractures (OR 8.41 CI 95%: 2.12-33.33), scalp lesions (OR 2.31 CI 95%: 1.09-4.89), but none of antithrombotic drugs were independently associated with ICH.
CONCLUSION
mTBI-related ICH rate was similar in patients with and without antithrombotic use. Potential predictors of ICH can be drawn from patients' clinical examination.
背景
在接受抗血栓治疗的轻度创伤性脑损伤（mTBI）患者中，颅内出血（ICH）的风险尚不清楚。我们比较了接受单药、双联和无抗血栓治疗的 mTBI 患者的 ICH 发生率。抗血栓药物包括维生素 K 拮抗剂（VKA）、直接口服抗凝剂（DOAC）和抗血小板药物。次要目的是确定 ICH 的潜在预测因素。
方法
我们回顾性分析了连续就诊于我院急诊科的 mTBI 成年患者。所有临床信息均通过患者病历回顾获得。患者被分为 5 组：1）无抗血栓药物使用者，2）抗血小板药物使用者，3）维生素 K 拮抗剂使用者，4）直接口服抗凝剂使用者，和 5）双联抗血栓药物使用者。
结果
共纳入 1846 例患者，平均年龄 71 岁（IQR 46-83）；1222 例（66.2%）患者在第 1 组，407 例（22.0%）在第 2 组，120 例（6.5%）在第 3 组，51 例（2.7%）在第 4 组，46 例（2.5%）在第 5 组。入组时，1387 例（75.1%）患者行颅脑 CT 检查，第 1 组 787 例（64.4%），第 2 组 387 例（95.1%），第 3 组 119 例（99.2%），第 4 组 51 例（100%），第 5 组 43 例（93.5%）。第 1 组中 36 例（4.6%；95%CI：3.2-6.3），第 2 组中 22 例（5.9%；95%CI：3.6-8.5），第 3 组中 5 例（4.2%；95%CI：1.4-9.5），第 4 组中 2 例（3.9%；95%CI：0.5-13.5），第 5 组中 3 例（7.0%；95%CI：1.5-19.1）发生 ICH（各组间比较的 p 值=0.86）。多变量分析显示 GCS<15（OR 7.95，95%CI：3.12-20.28）、创伤后遗忘（OR 6.49；95%CI：3.57-11.82）、呕吐（OR 4.45；95%CI：1.47-13.50）、颅面骨折的临床体征（OR 8.41；95%CI：2.12-33.33）、头皮损伤（OR 2.31；95%CI：1.09-4.89），但没有一种抗血栓药物与 ICH 独立相关。
结论
在接受抗血栓治疗和未接受抗血栓治疗的 mTBI 患者中，ICH 的发生率相似。ICH 的潜在预测因素可以从患者的临床检查中得出。
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