Mathieu François, Malhotra Armaan K, Ku Jerry C, Zeiler Frederick A, Wilson Jefferson R, Pirouzmand Farhad, Scales Damon C
Division of Neurosurgery, Department of Surgery, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Interdepartmental Division of Critical Care Medicine, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Neurotrauma Rep. 2022 Aug 10;3(1):308-320. doi: 10.1089/neur.2022.0042. eCollection 2022.
There is an increasing number of trauma patients presenting on pre-injury antiplatelet (AP) agents attributable to an aging population and expanding cardio- or cerebrovascular indications for antithrombotic therapy. The effects of different AP regimens on outcomes after traumatic brain injury (TBI) have yet to be elucidated, despite the implications on patient/family counseling and the potential need for better reversal strategies. The goal of this systematic review and meta-analysis was to assess the impact of different pre-injury AP regimens on outcomes after TBI. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the OVID Medline, Embase, BIOSIS, Scopus, and Cochrane databases were searched from inception to February 2022 using a combination of terms pertaining to TBI and use of AP agents. Baseline demographics and study characteristics as well as outcome data pertaining to intracerebral hematoma (ICH) progression, need for neurosurgical intervention, hospital length of stay, mortality, and functional outcome were extracted. Pooled odds ratios (ORs) and mean differences comparing groups were calculated using random-effects models. Thirteen observational studies, totaling 1244 patients receiving single AP therapy with acetylsalicylic acid or clopidogrel, 413 patients on dual AP therapy, and 3027 non-AP users were included. No randomized controlled trials were identified. There were significant associations between dual AP use and ICH progression (OR, 2.81; 95% confidence interval [CI], 1.19-6.61; , 85%; = 0.02) and need for neurosurgical intervention post-TBI (OR, 1.61; 95% CI, 1.15-2.28; , 15%; = 0.006) compared to non-users, but not between single AP therapy and non-users. There were no associations between AP use and hospital length of stay or mortality after trauma. Pre-injury dual AP use, but not single AP use, is associated with higher rates of ICH progression and neurosurgical intervention post-TBI. However, the overall quality of studies was low, and this association should be further investigated in larger studies.
由于人口老龄化以及抗血栓治疗的心血管或脑血管适应症不断扩大，越来越多的创伤患者在受伤前服用抗血小板（AP）药物。尽管不同的AP治疗方案对创伤性脑损伤（TBI）后结局的影响尚无定论，但其对患者/家属咨询以及更好的逆转策略的潜在需求具有重要意义。本系统评价和荟萃分析的目的是评估受伤前不同AP治疗方案对TBI后结局的影响。根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，从数据库创建到2022年2月，检索了OVID Medline、Embase、BIOSIS、Scopus和Cochrane数据库，使用了与TBI和AP药物使用相关的术语组合。提取了基线人口统计学和研究特征，以及与脑内血肿（ICH）进展、神经外科干预需求、住院时间、死亡率和功能结局相关的结局数据。使用随机效应模型计算比较组的合并比值比（OR）和均值差异。纳入了13项观察性研究，共1244例接受阿司匹林或氯吡格雷单药AP治疗的患者、413例接受双药AP治疗的患者和3027例未使用AP的患者。未检索到随机对照试验。与未使用者相比，双药AP使用与ICH进展（OR，2.81；95%置信区间[CI]，1.19 - 6.61；I²，85%；P = 0.02）和TBI后神经外科干预需求（OR，1.61；95% CI，1.15 - 2.28；I²，15%；P = 0.006）之间存在显著关联，但单药AP治疗与未使用者之间无此关联。AP使用与创伤后的住院时间或死亡率之间无关联。受伤前使用双药AP而非单药AP与TBI后ICH进展和神经外科干预的发生率较高相关。然而，研究的总体质量较低，这种关联应在更大规模的研究中进一步调查。
