Gao Fei, Ge Shunnan, Cui Wenxing, Zhao Jingya, Yang Yang, Guo Wei, Bai Hao, Wang Bao, Yang Chen, Mu Shijie, Wang Liang, Zhao Tianzhi, Qu Yan, Cai Yaning
Department of Neurosurgery, Tangdu Hospital, Xi'an, China.
Department of Neurosurgery, The 986 Hospital of PLAAF, Xi'an, China.
Heliyon. 2024 Feb 28;10(5):e26854. doi: 10.1016/j.heliyon.2024.e26854. eCollection 2024 Mar 15.
Studies have been inconclusive on the risk for hemorrhage in patients with a history of aspirin use who underwent emergency external ventricular drainage (EVD)/intracranial pressure (ICP) probe placement. The aim of this study was to explore hemorrhage-related risk factors in order to reduce the risk for hemorrhage in these patients.
Between July 2014 and July 2020, patients were retrospectively divided into EVD/ICP-related hemorrhage and non-hemorrhage groups. The collected data included age, gender, major diagnosis, medical history, imaging examinations, conventional coagulation test data, thromboelastography with platelet mapping (TEG-PM), surgical procedures and discharge conditions.
In total 94 patients, 21 in the hemorrhage group (15 males, 6 females) and 73 in the non-hemorrhage group (52 males, 21 females) were included. The majority of hemorrhages were recorded in EVD patients (19/21; 90.5%). Platelet AA pathway inhibition rate of ≥75% (sensitivity: 79.45% specificity: 52.38%) ( = 0.014) and SBP ≥125 mmHg ( = 0.006) were significantly related to hemorrhage. When the platelet AA pathway inhibition rate was ≥75% and the during-procedure SBP was ≥125 mmHg, the hemorrhage rate was significantly higher (83.3%) than with SBP <125 mmHg (6.7%) ( < 0.001). When the inhibition rate was <75%, there were no significant differences in the hemorrhage rates between the during-procedure SBP ≥125 mmHg group (17.2%) and the SBP <125 mmHg group (13.2%) ( > 0.05). Multivariate logistic regression analysis revealed that a platelet AA pathway inhibition rate ≥75% (OR = 5.183, 95% CI: 1.683-15.960) and during-procedure SBP ≥125 mmHg (OR = 4.609, 95% CI: 1.466-14.484) were independent risk factors for EVD/ICP-related hemorrhage.
Patients with long-term aspirin therapy, a platelet AA pathway inhibition rate ≥75% and during-procedure SBP ≥125 mmHg had a significantly higher risk of hemorrhage, which could be reduced by adjusting the SBP to <125 mmHg.
对于有阿司匹林使用史且接受紧急体外脑室引流（EVD）/颅内压（ICP）探头置入的患者，出血风险的研究尚无定论。本研究旨在探索与出血相关的危险因素，以降低这些患者的出血风险。
2014年7月至2020年7月期间，将患者回顾性分为EVD/ICP相关出血组和非出血组。收集的数据包括年龄、性别、主要诊断、病史、影像学检查、常规凝血试验数据、血小板功能分析的血栓弹力图（TEG-PM）、手术操作和出院情况。
共纳入94例患者，出血组21例（男性15例，女性6例），非出血组73例（男性52例，女性21例）。大多数出血发生在EVD患者中（19/21；90.5%）。血小板花生四烯酸（AA）途径抑制率≥75%（敏感性：79.45%，特异性：52.38%）（P = 0.014）和收缩压（SBP）≥125 mmHg（P = 0.006）与出血显著相关。当血小板AA途径抑制率≥75%且术中SBP≥125 mmHg时，出血率显著高于SBP <125 mmHg时（83.3%比6.7%）（P < 0.001）。当抑制率<75%时，术中SBP≥125 mmHg组（17.2%）和SBP <125 mmHg组（13.2%）的出血率无显著差异（P > 0.05）。多因素logistic回归分析显示，血小板AA途径抑制率≥75%（比值比[OR]=5.183，95%置信区间[CI]：1.683 - 15.960）和术中SBP≥125 mmHg（OR = 4.609，95% CI：1.466 - 14.484）是EVD/ICP相关出血的独立危险因素。
长期接受阿司匹林治疗、血小板AA途径抑制率≥75%且术中SBP≥125 mmHg的患者出血风险显著更高，可通过将SBP调整至<125 mmHg来降低风险。
