Karamian Armin, Seifi Ali, Lucke-Wold Brandon
School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Neurosurgery, University of Texas Health at San Antonio, San Antonio, Texas, USA.
Brain Inj. 2024 Dec 5;38(14):1197-1211. doi: 10.1080/02699052.2024.2392163. Epub 2024 Aug 14.
With the increasing cases of TBI cases in the elderly population taking anticoagulants for comorbidities, there is a need to better understand the safety of new anticoagulants and how to manage anticoagulated TBI patients.
A meta-analysis using a random-effect model was conducted to compare the effect of preinjury use of DOACs and VKAs on the outcomes following TBI.
From 1951 studies, 49 studies with a total sample size of 15,180 met our inclusion criteria. Our meta-analysis showed no difference between preinjury use of DOACs or VKAs on ICH progression, in-hospital delayed ICH, delayed ICH at follow-up, and in-hospital mortality, but using DOACs was associated with a lower risk of immediate ICH (OR = 0.58; 95% CI = [0.42; 0.79]; < 0.01) and neurosurgical interventions (OR = 0.59; 95% CI = [0.42; 0.82]; < 0.01) compared to VKAs. Moreover, patients on DOACs experienced shorter length of stay in the hospital than those on VKAs (OR = -0.42; 95% CI = [-0.78; -0.07]; = 0.02).
We found a lower risk of immediate ICH and surgical interventions as well as a shorter hospital stay in patients receiving DOACs compared to VKA users before the head injury.
随着老年人群中因合并症服用抗凝剂而发生创伤性脑损伤（TBI）的病例不断增加，有必要更好地了解新型抗凝剂的安全性以及如何管理接受抗凝治疗的TBI患者。
采用随机效应模型进行荟萃分析，以比较伤前使用直接口服抗凝剂（DOACs）和维生素K拮抗剂（VKAs）对TBI后结局的影响。
从1951项研究中，有49项研究（总样本量为15180）符合我们的纳入标准。我们的荟萃分析表明，伤前使用DOACs或VKAs在脑出血（ICH）进展、院内迟发性ICH、随访时迟发性ICH和院内死亡率方面没有差异，但与VKAs相比，使用DOACs与即刻ICH风险较低（比值比[OR]=0.58；95%置信区间[CI]=[0.42；0.79]；P<0.01）和神经外科干预风险较低（OR=0.59；95%CI=[0.42；0.82]；P<0.01）相关。此外，与服用VKAs的患者相比，服用DOACs的患者住院时间更短（OR=-0.42；95%CI=[-0.78；-0.07]；P=0.02）。
我们发现，与伤前服用VKAs的患者相比，接受DOACs治疗的患者发生即刻ICH和手术干预的风险较低，且住院时间较短。
