Clinical Sciences, Lund University, Svartbrödragränden 3-5, 251 87, Helsingborg, Sweden.
Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University Hospital, Sheikh Zayed, Egypt.
Eur J Trauma Emerg Surg. 2022 Dec;48(6):4909-4917. doi: 10.1007/s00068-022-02016-8. Epub 2022 Jun 22.
Traumatic brain injury (TBI) is a common injury and constitutes up to 3% of emergency department (ED) visits. Current studies show that TBI is most commonly inflicted in older patients after ground-level falls. These patients often take medications affecting coagulation such as anticoagulants or antiplatelet drugs. Guidelines for ED TBI-management assume that anticoagulation therapy (ACT) confers a higher risk of traumatic intracranial hemorrhage (TICH) than antiplatelet therapy (APT). However, recent studies have challenged this. This study aimed to evaluate if oral anticoagulation and platelet inhibitors affected rate of TICH in head-trauma patients with ground-level falls.
This was a retrospective review of medical records during January 1, 2017 to December 31, 2017 and January 1 2020 to December 31, 2020 of all patients seeking ED care because of head-trauma. Patients ≥ 18 years with ground-level falls were included.
The study included 1938 head-trauma patients with ground-level falls. Median age of patients with TICH was 81 years. The RR for TICH in APT-patients compared to patients without medication affecting coagulation was 1.72 (p = 0.01) (95% Confidence Interval (CI) 1.13-2.60) and 1.08 (p = 0.73), (95% CI 0.70-1.67) in ACT-patients. APT was independently associated with TICH in regression analysis (OR 1.59 (95% CI 1.02-2.49), p = 0.041).
This study adds to the growing evidence that APT-patients with ground-level falls might have as high or higher risk of TICH than ACT-patients. This is not addressed in the current guidelines which may need to be updated. We therefore recommend broad prospective studies.
颅脑创伤（TBI）是一种常见的损伤，占急诊科（ED）就诊的比例高达 3%。目前的研究表明，TBI 最常发生在老年患者从地面坠落之后。这些患者经常服用影响凝血的药物，如抗凝剂或抗血小板药物。ED TBI 管理指南假设抗凝治疗（ACT）比抗血小板治疗（APT）导致创伤性颅内出血（TICH）的风险更高。然而，最近的研究对此提出了质疑。本研究旨在评估口服抗凝剂和血小板抑制剂是否会影响因地面坠落导致头部外伤的患者的 TICH 发生率。
这是一项回顾性病历研究，纳入了 2017 年 1 月 1 日至 2017 年 12 月 31 日和 2020 年 1 月 1 日至 2020 年 12 月 31 日期间因头部外伤到 ED 就诊的所有患者。纳入年龄≥18 岁且因地面坠落导致头部外伤的患者。
本研究纳入了 1938 例因地面坠落导致头部外伤的患者。TICH 患者的中位年龄为 81 岁。与未服用影响凝血药物的患者相比，APT 患者发生 TICH 的 RR 为 1.72（p=0.01）（95%置信区间（CI）为 1.13-2.60），ACT 患者的 RR 为 1.08（p=0.73）（95%CI 为 0.70-1.67）。APT 在回归分析中与 TICH 独立相关（OR 1.59（95%CI 1.02-2.49），p=0.041）。
本研究增加了越来越多的证据，表明与 ACT 患者相比，因地面坠落导致头部外伤的 APT 患者发生 TICH 的风险可能更高或更高。这在当前的指南中并未得到解决，可能需要更新。因此，我们建议进行广泛的前瞻性研究。
