口服抗凝剂治疗出血性创伤性脑损伤的管理策略及结果
Management Strategies and Outcomes of Hemorrhagic Traumatic Brain Injury on Oral Anticoagulants.
作者信息
Krueger Evan M, Finneran Megan M, Smith Michelle
机构信息
Department of Neurosurgery, Carle Foundation Hospital, Normal, USA.
Department of Trauma, OSF Healthcare, Bloomington, USA.
出版信息
Cureus. 2020 Sep 17;12(9):e10508. doi: 10.7759/cureus.10508.
INTRODUCTION
Traumatic brain injury (TBI) is common, and the frequency of patients taking oral anticoagulants is increasing. However the optimal initial triage, management, and long term care plans of hemorrhagic TBI patients taking oral anticoagulants is not clear.
OBJECTIVES
To determine the usage pattern of reversal agents for hemorrhagic TBI patients taking oral anticoagulants, and examine their characteristics and outcomes as compared to hemorrhagic TBI patients not taking these medications.
METHODS
This was a single-center, retrospective, observational study. Included were adults with trauma categorization and traumatic intracranial hemorrhage (ICH) between April 1, 2017 and December 31, 2019. Patient age, type of ICH, initial Glasgow Coma Scale (GCS) score, oral anticoagulant prescribed pre-injury, anticoagulation reversal agent given, and hospital discharge disposition were recorded.
RESULTS
For the entire sample size (n=111), the mean age and GCS were 71.6 years old and 13.8, respectively. Compared to patients not taking oral anticoagulants, patients taking oral anticoagulants were older (76.7 years old versus 69.1; <0.01), had similar GCS scores (13.7 versus 13.9; =0.69), had fewer subarachnoid hemorrhages (18.9% versus 37.8%; =0.04), were less likely to discharge home (48.6% versus 73.0%; =0.01), and had similar incidence of mortality (13.5% versus 6.7%; =0.30). A total of 14/37 (37.8%) patients taking oral anticoagulants received reversal agents in the emergency department. Compared to patients taking oral anticoagulants and not given reversal agents, patients taking oral anticoagulants and given reversal agents had similar ages (78.8 years old versus 75.4; =0.41), had similar GCS scores (12.9 versus 14.1; =0.17), had similar ICH types (all =1.0), were less likely to discharge home (48.6% versus 73.0%; =0.01), and had higher incidence of mortality (28.6% versus 4.2%; =0.05).
CONCLUSIONS
This limited data set did not show improved outcomes by giving reversal agents to hemorrhagic TBI patients taking oral anticoagulants. However, until more robust data is available, judicious use of reversal agents in this high-risk patient population should remain common practice.
引言
创伤性脑损伤（TBI）很常见，服用口服抗凝剂的患者数量也在增加。然而，服用口服抗凝剂的出血性TBI患者的最佳初始分诊、管理和长期护理计划尚不清楚。
目的
确定服用口服抗凝剂的出血性TBI患者使用逆转剂的模式，并与未服用这些药物的出血性TBI患者相比，检查其特征和结果。
方法
这是一项单中心、回顾性观察研究。纳入了2017年4月1日至2019年12月31日期间有创伤分类和创伤性颅内出血（ICH）的成年人。记录患者年龄、ICH类型、初始格拉斯哥昏迷量表（GCS）评分、伤前开具的口服抗凝剂、给予的抗凝逆转剂以及出院处置情况。
结果
对于整个样本量（n = 111），平均年龄和GCS分别为71.6岁和13.8。与未服用口服抗凝剂的患者相比，服用口服抗凝剂的患者年龄更大（76.7岁对69.1岁；<0.01），GCS评分相似（13.7对13.9；=0.69），蛛网膜下腔出血较少（18.9%对37.8%；=0.04），出院回家的可能性较小（48.6%对73.0%；=0.01），死亡率发生率相似（13.5%对6.7%；=0.30）。共有14/37（37.8%）服用口服抗凝剂的患者在急诊科接受了逆转剂。与服用口服抗凝剂但未给予逆转剂的患者相比，服用口服抗凝剂并给予逆转剂的患者年龄相似（78.8岁对75.4岁；=0.41），GCS评分相似（12.9对14.1；=0.17），ICH类型相似（均=1.0），出院回家的可能性较小（48.6%对73.0%；=0.01），死亡率发生率更高（28.6%对4.2%；=0.05）。
结论
这个有限的数据集没有显示给服用口服抗凝剂的出血性TBI患者使用逆转剂能改善结果。然而，在获得更有力的数据之前，在这个高危患者群体中明智地使用逆转剂仍应是常见做法。
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