抗凝相关脑出血的血肿位置和形态。
Hematoma location and morphology of anticoagulation-associated intracerebral hemorrhage.
机构信息
From the Stroke Research Group (D.J.S., D.W.), UCL Queen Square Institute of Neurology, University College London and the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Stroke Centre and Neurology (D.J.S.), University Hospital and University Basel, Switzerland; Department of Neurology (S.C., T.T.), Helsinki University Hospital, Finland; Degenerative & Vascular Cognitive Disorders, Department of Neurology (N.D.-P., C.C.), INSERM U1171, CHU Lille, University of Lille, France; Department of Clinical and Experimental Sciences, Neurology Clinic (A.P.), University of Brescia, Italy; Department of Clinical Neuroscience/Neurology (T.T.), Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden.
出版信息
Neurology. 2019 Feb 19;92(8):e782-e791. doi: 10.1212/WNL.0000000000006958. Epub 2019 Jan 23.
OBJECTIVE
To study hematoma location and morphology of intracerebral hemorrhage (ICH) associated with oral anticoagulants (OAC) and delineate causes and mechanism.
METHODS
We performed a systematic literature research and meta-analysis of studies comparing neuroimaging findings in patients with OAC-ICH compared to those with ICH not associated with OAC (non-OAC ICH). We calculated pooled risk ratios (RRs) for ICH location using the Mantel-Haenszel random-effects method and corresponding 95% confidence intervals (95% CI).
RESULTS
We identified 8 studies including 6,259 patients (OAC-ICH n = 1,107, pooled OAC-ICH population 17.7%). There was some evidence for deep ICH location (defined as ICH in the thalamus, basal ganglia, internal capsule, or brainstem) being less frequent in patients with OAC-ICH (OAC-ICH: 450 of 1,102/40.8% vs non-OAC ICH: 2,656 of 4,819/55.1%; RR 0.94, 95% CI 0.88-1.00, = 0.05, = 0%) while cerebellar ICH location was significantly more common in OAC-ICH (OAC-ICH: 111 of 1,069/10.4% vs non-OAC ICH: 326 of 4,787/6.8%; RR 1.45, 95% CI 1.12-1.89, = 0.005, = 21%) compared to non-OAC ICH. There was no statistically significant relationship to OAC use for lobar (OAC-ICH: 423 of 1,107/38.2% vs non-OAC ICH: 1,884 of 5,152/36.6%; RR 1.02, 95% CI 0.89-1.17, = 0.75, = 53%, for heterogeneity = 0.04) or brainstem ICH (OAC-ICH: 36 of 546/6.6% vs non-OAC ICH: 172 of 2,626/6.5%; RR 1.04, 95% CI 0.58-1.87, = 0.89, = 59%, for heterogeneity = 0.04). The risk for intraventricular extension (OAC-ICH: 436 of 840/51.9% vs non-OAC ICH: 1,429 of 3,508/40.7%; RR 1.26, 95% CI 1.16-1.36, < 0.001, = 0%) was significantly increased in patients with OAC-ICH. We found few data on ICH morphology in OAC-ICH vs non-OAC ICH.
CONCLUSION
The overrepresentation of cerebellar ICH location and intraventricular extension in OAC-ICH might have mechanistic relevance for the underlying arteriopathy, pathophysiology, or bleeding pattern of OAC-ICH, and should be investigated further.
目的
研究与口服抗凝剂（OAC）相关的脑出血（ICH）的血肿位置和形态，并阐明其病因和机制。
方法
我们对比较 OAC-ICH 患者与非 OAC-ICH（非 OAC ICH）患者神经影像学发现的研究进行了系统的文献检索和荟萃分析。我们使用 Mantel-Haenszel 随机效应方法计算了血肿位置的汇总风险比（RR），并给出了相应的 95%置信区间（95% CI）。
结果
我们确定了 8 项研究，共纳入 6259 名患者（OAC-ICH n = 1107 例，汇总 OAC-ICH 人群 17.7%）。OAC-ICH 患者深部 ICH 位置（定义为丘脑、基底节、内囊或脑干内的 ICH）较非 OAC ICH 患者少见（OAC-ICH：1102/40.8%，非 OAC ICH：2656/55.1%；RR 0.94，95% CI 0.88-1.00， = 0.05， = 0%），而小脑 ICH 位置在 OAC-ICH 患者中更为常见（OAC-ICH：1069/10.4%，非 OAC ICH：326/4787/6.8%；RR 1.45，95% CI 1.12-1.89， = 0.005， = 21%）。OAC 与大脑皮质（OAC-ICH：1107/38.2%，非 OAC ICH：5152/36.6%；RR 1.02，95% CI 0.89-1.17， = 0.75， = 53%， 异质性=0.04）或脑干（OAC-ICH：546/6.6%，非 OAC ICH：2626/6.5%；RR 1.04，95% CI 0.58-1.87， = 0.89， = 59%， 异质性=0.04）ICH 之间无统计学显著相关性。OAC-ICH 患者发生脑室内延伸（OAC-ICH：840/51.9%，非 OAC ICH：3508/40.7%；RR 1.26，95% CI 1.16-1.36， < 0.001， = 0%）的风险显著增加。我们发现 OAC-ICH 与非 OAC ICH 之间 ICH 形态的相关数据较少。
结论
OAC-ICH 中小脑 ICH 位置和脑室内延伸的过度表现可能与 OAC-ICH 的潜在血管病变、病理生理学或出血模式具有机制相关性，值得进一步研究。
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