Clinical Sciences, Malmö, Clinical Research Centre, CRC, Lund University, Plan 11, Jan Waldenströms Gata 35, Malmö, Sweden.
Clinical Sciences, Helsingborg, Lund University, Svartbrödragränden 3-5, 251 87, Helsingborg, Sweden.
Eur J Trauma Emerg Surg. 2024 Aug;50(4):1237-1248. doi: 10.1007/s00068-024-02493-z. Epub 2024 Mar 21.
Traumatic brain injury is the main reason for the emergency department visit of up to 3% of the patients and a major worldwide cause for morbidity and mortality. Current emergency management guidelines recommend close attention to patients taking oral anticoagulation but not patients on antiplatelet therapy. Recent studies have begun to challenge this. The aim of this study was to determine the impact of antiplatelet therapy and oral anticoagulation on traumatic intracranial hemorrhage.
Medical records of adult patients triaged with "head injury" as the main reason for emergency care were retrospectively reviewed from January 1, 2017, to December 31, 2017, and January 1, 2020, to December 31, 2021. Patients ≥ 18 years with head trauma were included. Odds ratio was calculated, and multiple logistic regression was performed.
A total of 4850 patients with a median age of 70 years were included. Traumatic intracranial hemorrhage was found in 6.2% of the patients. The risk ratio for traumatic intracranial hemorrhage in patients on antiplatelet therapy was 2.25 (p < 0.001, 95% confidence interval 1.73-2.94) and 1.38 (p = 0.002, 95% confidence interval 1.05-1.84) in patients on oral anticoagulation compared to patients without mediations that affect coagulation. In binary multiple regression, antiplatelet therapy was associated with intracranial hemorrhage, but oral anticoagulation was not.
This study shows that antiplatelet therapy is associated with a higher risk of traumatic intracranial hemorrhage compared to oral anticoagulation. Antiplatelet therapy should be given equal or greater consideration in the guidelines compared to anticoagulation therapy. Further studies on antiplatelet subtypes within the context of head trauma are recommended to improve the guidelines' diagnostic accuracy.
创伤性脑损伤是导致高达 3%的患者前往急诊就诊的主要原因，也是全球范围内发病率和死亡率的主要原因。目前的急救管理指南建议密切关注正在服用口服抗凝剂的患者，但不关注正在服用抗血小板治疗的患者。最近的研究开始对此提出质疑。本研究旨在确定抗血小板治疗和口服抗凝剂对创伤性颅内出血的影响。
回顾性分析 2017 年 1 月 1 日至 12 月 31 日和 2020 年 1 月 1 日至 12 月 31 日因“头部损伤”作为主要急救原因分诊的成年患者的医疗记录。纳入有头部外伤的≥18 岁患者。计算比值比，并进行多因素逻辑回归。
共纳入 4850 名中位年龄为 70 岁的患者。6.2%的患者发生创伤性颅内出血。与未接受影响凝血的药物治疗的患者相比，抗血小板治疗患者发生创伤性颅内出血的风险比为 2.25（p<0.001，95%置信区间 1.73-2.94）和 1.38（p=0.002，95%置信区间 1.05-1.84），而口服抗凝剂患者发生创伤性颅内出血的风险比为 1.38（p=0.002，95%置信区间 1.05-1.84）。在二元多因素回归中，抗血小板治疗与颅内出血相关，而口服抗凝治疗则无此相关性。
本研究表明，与口服抗凝治疗相比，抗血小板治疗与创伤性颅内出血的风险增加相关。在指南中，抗血小板治疗应与抗凝治疗同等或更受重视。建议在头部外伤的背景下进一步研究抗血小板的亚类，以提高指南的诊断准确性。
