Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
World Neurosurg. 2019 May;125:e671-e677. doi: 10.1016/j.wneu.2019.01.151. Epub 2019 Feb 5.
Antiplatelet therapy is common and complicates the operative management of subdural hematomas (SDH). The risk of reoperation inferred by antiplatelet medication and the ability of platelet transfusion to reduce hemorrhagic complications in patients presenting with antiplatelet associated SDHs are poorly defined.
We performed a retrospective review of consecutive patients treated with craniotomy or craniectomy for evacuation of an acute or mixed-density SDH between 2012 and 2017 at 2 academic institutions. Exclusion criteria included anticoagulant therapy, thrombocytopenia, and/or international normalized ratio >1.3. Clinical and radiographic data were collected; primary endpoint was reoperation within 30 days. Logistic regression models were used to identify predictors of reoperation.
A total of 195 patients were included: 86 patients on antiplatelet medication and 109 with no antithrombotic history. Overall, 24 (12.3%) of patients required a reoperation. Reoperation rate in patients on antiplatelet medication was not significantly different than those not on antithrombotics (14.0% vs. 11.0%, P = 0.53). Patients taking antiplatelet medication were significantly older, more likely to have medical comorbidities, and more likely to receive preoperative platelet transfusion (36.0% vs. 3.7%, P < 0.001). Of patients taking antiplatelet medications, there was no difference in reoperation rate between those patients receiving preoperative platelet transfusion and those not receiving transfusion (16.1% vs. 12.7%, P = 0.75).
Antiplatelet medication was not a significant predictor of reoperation following evacuation of an acute or mixed-density SDH. In patients on antiplatelet medication, preoperative platelet transfusion did not reduce reoperation rates.
抗血小板治疗很常见，并且使硬膜下血肿（SDH）的手术管理复杂化。抗血小板药物引起的再手术风险以及血小板输注降低接受抗血小板相关 SDH 患者出血并发症的能力尚未明确。
我们对 2012 年至 2017 年在 2 所学术机构接受开颅或颅骨切除术治疗急性或混合密度 SDH 的连续患者进行了回顾性研究。排除标准包括抗凝治疗、血小板减少症和/或国际标准化比值>1.3。收集临床和影像学数据；主要终点是 30 天内再次手术。使用逻辑回归模型来确定再次手术的预测因素。
共纳入 195 例患者：86 例服用抗血小板药物，109 例无抗血栓病史。总体而言，24 例（12.3%）患者需要再次手术。服用抗血小板药物的患者的再手术率与未服用抗血栓药物的患者无显著差异（14.0%与 11.0%，P=0.53）。服用抗血小板药物的患者年龄较大，合并症更多，更有可能接受术前血小板输注（36.0%与 3.7%，P<0.001）。服用抗血小板药物的患者中，接受术前血小板输注和未接受输注的患者之间的再手术率无差异（16.1%与 12.7%，P=0.75）。
抗血小板药物不是急性或混合密度 SDH 清除术后再次手术的显著预测因素。在服用抗血小板药物的患者中，术前血小板输注并未降低再手术率。
