Andes W A, Wulff K, Smith W B
Arch Intern Med. 1984 Oct;144(10):1981-3.
Intracranial hemorrhage (ICH) remains a serious problem in hemophilia. Consecutive episodes of ICH or reports of head trauma were prospectively recorded in 140 patients with hemophilia seen during a two-year period. Forty of 48 consecutive episodes of ICH or trauma occurred in 37 patients with severe disease (less than 1% factor VIII or IX). Five injured patients had inhibitors to factor VIII. Two fatalities occurred following injury and one patient died following a spontaneous bleed. Injury in 40 instances warranted replacement therapy. No patient given coagulation factor within six hours of injury experienced ICH. The risk of ICH following head trauma (13% in this series) warrants aggressive use of coagulation factor replacement. Watchfulness in dealing with such patients and early therapy may be more necessary than often realized.
颅内出血（ICH）仍是血友病患者面临的一个严重问题。在两年时间里对140例血友病患者进行前瞻性记录，统计其连续发生的颅内出血事件或头部创伤报告。在48例连续发生的颅内出血或创伤事件中，有40例发生在37例重症患者（因子VIII或IX水平低于1%）身上。5例受伤患者体内存在针对因子VIII的抑制物。有2例患者受伤后死亡，1例患者因自发性出血死亡。40例受伤情况需要进行替代治疗。在受伤后6小时内接受凝血因子治疗的患者均未发生颅内出血。头部创伤后发生颅内出血的风险（本系列研究中为13%）表明需要积极使用凝血因子进行替代治疗。在处理这类患者时保持警惕并尽早治疗可能比通常意识到的更为必要。
