Eibinger Nicolas, Halvachizadeh Sascha, Hallmann Barbara, Seibert Franz Josef, Puchwein Paul, Berk Till, Lefering Rolf, Sprengel Kai, Pape Hans Christoph, Jensen Kai Oliver
Division of Trauma Surgery, Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria.
Department of Trauma, University Hospital Zurich, 8091 Zürich, Switzerland.
Brain Sci. 2020 Nov 12;10(11):842. doi: 10.3390/brainsci10110842.
The purpose of this study was to assess anticoagulant medication as an independent factor influencing the occurrence of a severe traumatic brain injury in geriatric patients. Data were collected from the TraumaRegister DGU between January 2015 and December 2018. We included patients with an age of ≥65 years with a blunt TBI; an AISHead ≥2 but no other relevant injuries. Patients were divided into five subgroups: no anticoagulant medication, anti-platelet drugs, vitamin K antagonists, direct-oral-anticoagulants, and heparinoids. Separation between moderate TBI (AISHead 2-3) and severe TBI (AISHead ≥ 4) and multivariable regression analysis were performed. The average age of 10,559 included patients was 78.8 years with a mean ISS of 16.8 points and a mortality of 22.9%. The most common cause of injury was a low fall of <3 m with 72.8%. With increasing age, the number of patients without any anticoagulant therapy decreased from 65.9% to 29.9%. The intake of coagulation medication increased mortality significantly. Severe TBI was observed in 51% of patients without medication and ranged from 61 to 67% with anticoagulant drugs. After adjusting for confounding variables, the intake of VKA or DOACs was significantly associated with an increased risk of severe TBI. The use of anticoagulant medication is an independent factor and is associated with an increased severity of TBI depending on the type of medication used.
本研究的目的是评估抗凝药物作为影响老年患者严重创伤性脑损伤发生的独立因素。数据收集自2015年1月至2018年12月的创伤登记数据库DGU。我们纳入了年龄≥65岁的钝性颅脑损伤患者；简明损伤定级标准（AIS）头部评分≥2但无其他相关损伤。患者被分为五个亚组：未使用抗凝药物、抗血小板药物、维生素K拮抗剂、直接口服抗凝剂和类肝素。进行了中度颅脑损伤（AIS头部评分2 - 3）和重度颅脑损伤（AIS头部评分≥4）的区分以及多变量回归分析。纳入的10559例患者的平均年龄为78.8岁，平均损伤严重度评分（ISS）为16.8分，死亡率为22.9%。最常见的损伤原因是<3米的低跌倒，占72.8%。随着年龄增长，未接受任何抗凝治疗的患者数量从65.9%降至29.9%。凝血药物的使用显著增加了死亡率。未用药患者中51%发生了重度颅脑损伤，使用抗凝药物的患者中这一比例在61%至67%之间。在调整混杂变量后，维生素K拮抗剂（VKA）或直接口服抗凝剂（DOACs）的使用与重度颅脑损伤风险增加显著相关。抗凝药物的使用是一个独立因素，并且根据所用药物类型与颅脑损伤严重程度增加相关。
