Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan.
Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung Medical College and University, Taoyuan, Taiwan.
World Neurosurg. 2019 Aug;128:e59-e73. doi: 10.1016/j.wneu.2019.03.269. Epub 2019 Apr 4.
The impact of antithrombotic agents on patients with primary intracerebral hemorrhage (ICH) remains controversial, especially patients who require emergent craniotomy. This study was undertaken to evaluate clinical outcomes in operated patients with ICH with and without previous antithrombotic agents.
This is a retrospective cohort study. Between January 2001 and December 2013, all patients with ICH who received emergent craniotomy and who were present in Taiwan's National Health Insurance Research Database were screened and divided into those with previous antiplatelet therapy, anticoagulant therapy, and nonantithrombotic therapy according to their health care claims data within 3 months of index admission. The primary end points included in-hospital mortality and complications and short-term outcome.
Of 18,872 eligible patients, 16,251 (87.1%) did not receive any antithrombotic therapy, 2267 patients had antiplatelet therapy, and 354 patients had anticoagulation therapy. After propensity score matching, significantly more blood transfusions and craniectomies were identified in the patients with previous antithrombotic treatment compared with those undergoing nonantithrombotic therapy. Compared with the nonantithrombotic treatment cohort, patients under previous anticoagulant treatment had significantly higher in-hospital mortality (odds ratio, 2.12; 95% confidence interval, 1.45-3.10). Furthermore, during the 6-month follow-up period, previous anticoagulant therapy was independently associated with a greater risk of all-cause mortality (P = 0.001). The in-hospital and 6-month all-cause mortality of patients with previous antiplatelet treatment was not significantly different from patients with nonantithrombotic treatment.
These findings suggested an increased risk of in-hospital mortality and poor short-term outcome among operated patients with ICH with previous antithrombotic therapy, particularly anticoagulant therapy, but not with antiplatelet therapy.
抗血栓药物对原发性脑出血（ICH）患者的影响仍存在争议，尤其是需要紧急开颅手术的患者。本研究旨在评估接受手术治疗的 ICH 患者中，有无抗血栓药物治疗的临床结局。
这是一项回顾性队列研究。2001 年 1 月至 2013 年 12 月期间，所有在台湾全民健康保险研究数据库中接受紧急开颅手术的 ICH 患者均接受筛查，并根据其入院前 3 个月的健康保险理赔数据，分为抗血小板治疗、抗凝治疗和无抗血栓治疗组。主要终点包括住院死亡率和并发症及短期预后。
在 18872 名合格患者中，16251 名（87.1%）未接受任何抗血栓治疗，2267 名患者接受抗血小板治疗，354 名患者接受抗凝治疗。经倾向评分匹配后，与未接受抗血栓治疗的患者相比，有抗血栓治疗史的患者接受了更多的输血和开颅手术。与非抗血栓治疗组相比，接受抗凝治疗的患者住院死亡率显著升高（比值比，2.12；95%置信区间，1.45-3.10）。此外，在 6 个月随访期间，接受抗凝治疗与全因死亡率增加独立相关（P=0.001）。接受抗血小板治疗的患者与未接受抗血栓治疗的患者相比，住院期间和 6 个月全因死亡率无显著差异。
这些发现表明，有抗血栓治疗史的 ICH 患者，尤其是抗凝治疗史，开颅术后住院死亡率和短期预后不良风险增加，但抗血小板治疗史无此风险。
