Retrospective Observational Study of Patients With Subdural Hematoma Treated With Idarucizumab

IF 1.8 Q3 CLINICAL NEUROLOGY
Eiichi Suehiro, Hideyuki Ishihara, Yohei Kogeichi, Tsunenori Ozawa, Koichi Haraguchi, Masaru Honda, Yumie Honda, Makoto Inaba, Ryusuke Kabeya, Naoaki Kanda, Kenta Koketsu, Nobukuni Murakami, Hidetoshi Nakamoto, Kotaro Oshio, Kuniyasu Saigusa, Takashi Shuto, Shuichi Sugiyama, Kenji Suzuyama, Tsuguaki Terashima, Mitsuharu Tsuura, Mitsutoshi Nakada, Hitoshi Kobata, Toshio Higashi, Nobuyuki Sakai, Michiyasu Suzuki
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引用次数: 0

Abstract

Use of anticoagulants is increasing with the aging of societies. The safe first-line drug is likely to be a direct oral anticoagulant (DOAC), but outcomes of treatment of traumatic brain injury (TBI) with anticoagulants are uncertain. Therefore, we examined the clinical effect of idarucizumab as reversal therapy in elderly patients with TBI who were treated with dabigatran. A retrospective multi-center observational study was performed in patients ≥65 years of age who developed acute traumatic subdural hematoma during treatment with dabigatran and underwent reversal therapy with idarucizumab. The items examined included patient background, neurological and imaging findings at arrival, course after admission, complications, and outcomes. A total of 23 patients were enrolled in the study. The patients had a mean age of 78.9 years. Cause of TBI was fall in 60.9% of the subjects. Mean Glasgow Coma Scale score at arrival was 8.7; anisocoria was present in 31.8% of cases. Exacerbation of consciousness was found in 30.4%, but only in 13.3% of subjects treated with idarucizumab before consciousness and imaging findings worsened. Dabigatran was discontinued in 81.8% of cases after hematoma development, with a mean withdrawal period of 12.1 days. The favorable outcome rate was 21.7%, and mortality was 39.1%. In multi-variate analysis, timing of idarucizumab administration was associated with a favorable outcome. There were ischemic complications in 3 cases (13.1%), and all three events occurred ≥7 days after administration of idarucizumab. These findings suggest that in cases that develop hematoma during treatment with dabigatran, it is important to administer idarucizumab early and restart dabigatran after conditions stabilize.
依达鲁珠单抗治疗硬膜下血肿患者的回顾性观察研究
抗凝血剂的使用随着社会的老龄化而增加。安全的一线药物可能是直接口服抗凝剂(DOAC),但使用抗凝剂治疗创伤性脑损伤(TBI)的结果尚不确定。因此,我们研究了idarucizumab作为逆转疗法在接受达比加群治疗的老年TBI患者中的临床效果。一项回顾性多中心观察性研究对≥65岁、在达比加群治疗期间出现急性外伤性硬膜下血肿并接受依达鲁单抗逆转治疗的患者进行了研究。检查的项目包括患者背景、到达时的神经学和影像学发现、入院后的病程、并发症和结果。共有23名患者参加了这项研究。患者的平均年龄为78.9岁。60.9%的受试者发生TBI的原因为跌倒。到达时格拉斯哥昏迷评分平均为8.7分;31.8%的病例存在异色性。30.4%的患者意识恶化,但在接受依达鲁珠单抗治疗的患者中,在意识和影像学表现恶化之前,意识恶化仅占13.3%。81.8%的血肿患者停药达比加群,平均停药期为12.1天。良好转归率为21.7%,死亡率为39.1%。在多变量分析中,idarucizumab给药的时机与有利的结果相关。3例(13.1%)出现缺血性并发症,这3例事件均发生在给予依达鲁珠单抗后≥7天。这些发现表明,在使用达比加群治疗期间出现血肿的病例中,早期给药依达鲁单抗并在病情稳定后重新使用达比加群是很重要的。
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来源期刊
CiteScore
2.40
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0.00%
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审稿时长
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