轻度脑外伤和抗血栓治疗的脑出血风险

IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
J.J. Martínez-Rivas , F. Rodríguez-Lucas , G. Planells , D. Corrales , D. Cocho
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引用次数: 0

摘要

摘要轻度外伤性脑损伤(mTBI)的观察时间存在争议。我们的目的是评估接受和不接受抗栓治疗的mTBI患者神经系统并发症的风险。方法回顾性评价急诊3年mTBI患者。我们考虑的是入院时格拉斯哥≥13的MTBI患者。所有有1个危险因素的患者入院时均行颅脑CT检查,有神经功能障碍或初次病理性颅脑CT检查的患者入院24小时行颅脑CT检查。对术后3个月的并发症进行回顾性分析。结果907例患者,平均年龄73±19岁。91%的患者存在危险因素,其中60%接受了抗血栓治疗。我们检测到11%的初始脑出血,24小时0.4%,3个月无病例。抗血栓治疗与脑出血风险增加无关(治疗组9.9% vs未治疗组11.9%,P= 0.3)。39%的出血患者出现神经系统症状(18%创伤后失忆,12%头痛,8%呕吐,1%癫痫发作),78.4%有轻微症状。24 h检测出4例出血,3例无症状,1例加重了最初的头痛。结论我们的研究表明,无症状mTBI患者,其初始颅脑CT未见病变,无论抗栓治疗或INR水平如何,均不需要观察期或CT对照。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Riesgo de hemorragia cerebral en el traumatismo craneal leve y tratamiento antitrombótico

Introduction

The observation time in mild traumatic brain injury (mTBI) is controversial. Our aim was to assess the risk of neurological complications in mTBI with and without antithrombotic treatment.

Method

We retrospectively evaluated patients with mTBI seen in the emergency room for 3 years. We considered MTBI those with Glasgow ≥13 at admission. A cranial CT was performed in all cases with >1 risk factor at admission and at 24 h in those with neurological impairment or initial pathological cranial CT. Complications in the following 3 months were retrospectively reviewed.

Results

We evaluated 907 patients with a mean age of 73 ± 19 years. Ninety-one percent presented risk factors, with 60% on antithrombotic treatment. We detected 11% of initial brain hemorrhage, 0.4% at 24 h, and no cases at 3 months. Antithrombotic treatment was not associated with an increased risk of brain hemorrhage (9.9% with vs. 11.9% without treatment, P=.3). 39% of the hemorrhages presented neurological symptoms (18% post-traumatic amnesia, 12% headache, 8% vomiting, 1% seizures), with 78.4% having mild symptoms. Of the 4 hemorrhages detected at 24 h, 3 were asymptomatic and one case that worsened the initial headache. No asymptomatic patient without lesion on initial clinical cranial CT presented at 24 h.

Conclusions

Our study suggests that patients with asymptomatic mTBI, without a lesion on the initial cranial CT, would not require the observation period or CT control regardless of antithrombotic treatment or INR level.

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来源期刊
Revista clinica espanola
Revista clinica espanola 医学-医学:内科
CiteScore
4.40
自引率
6.90%
发文量
73
审稿时长
28 days
期刊介绍: Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI). The journal fully endorses the goals of updating knowledge and facilitating the acquisition of key developments in internal medicine applied to clinical practice. Revista Clínica Española is subject to a thorough double blind review of the received articles written in Spanish or English. Nine issues are published each year, including mostly originals, reviews and consensus documents.
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