神经功能完好的创伤性颅内出血患者是否有必要逆转抗凝剂?

IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY
Pharmacotherapy Pub Date : 2024-03-01 Epub Date: 2024-01-02 DOI:10.1002/phar.2901
Kelly Powell, William Curtiss, Erin Sadek, Jason Hecht
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引用次数: 0

摘要

简介跌倒是老年人受伤的主要原因,而颅内出血(ICH)是常见的并发症。维生素 K 拮抗剂 (VKA) 和直接口服抗凝剂 (DOAC) 等抗凝剂的使用率越来越高,临床医生可能会质疑轻微 ICH 患者是否有必要逆转治疗,尤其是在不良事件风险增加的情况下。本研究旨在确定轻微创伤性 ICH 患者中神经功能状况不佳的低风险人群,在这些人群中逆转抗凝剂可能不会改善预后:这项回顾性队列研究利用了 2018 年至 2021 年期间从 35 个创伤中心获取的数据。纳入的患者均在受伤前接受了抗凝治疗,因钝性创伤导致 ICH,格拉斯哥昏迷量表(GCS)评分为 15 分,简易损伤量表(AIS)头部评分为 2 至 4 分,且在到达医院 24 小时内,非头部区域的 AIS 评分≤1 分。如果患者需要进行紧急神经外科手术或在受伤前服用嘌呤能-P2受体-12蛋白(P2Y12)抑制剂,则排除在外。主要结果是院内死亡率或临终关怀率:结果:共有 654 名在受伤前接受抗凝治疗的轻微创伤性 ICH 患者被纳入其中,这些患者均无神经功能缺损。总体而言,263 名患者接受了逆转治疗,391 名患者未接受逆转治疗。12例(4.6%)患者出现院内死亡或临终关怀,而19例(4.91%)患者未接受逆转治疗(P=0.861)。21例(8%)逆转患者和34例(8.7%)未逆转患者出现了综合住院并发症(P=0.748)。逆转组重症监护室平均住院时间为1.4±3.4天,未逆转组为1.1±1.8天(P=0.069):本研究发现,使用口服抗凝药的轻微外伤性 ICH 患者中,神经功能完好的患者接受逆转治疗与未接受逆转治疗的患者在住院治疗结果上没有差异。进一步的研究应继续确定哪些外伤性 ICH 患者可能不需要逆转抗凝治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Is reversal of anticoagulants necessary in neurologically intact traumatic intracranial hemorrhage?

Introduction: Falls are the leading cause of injury in older individuals, with intracranial hemorrhage (ICH) being a common complication. Anticoagulants, such as vitamin K antagonist and direct oral anticoagulants, are increasingly utilized, and clinicians may question the necessity of reversal in patients with minor ICH, especially in the setting of increased risk of adverse events. This study aimed to identify a population of patients with minor traumatic ICH at low risk for poor-neurologic status where anticoagulant reversal may not improve outcomes.

Methods: This retrospective cohort study utilized data accessed from 35 trauma centers from 2018 to 2021. Patients included had a preinjury anticoagulant regimen, ICH due to blunt trauma, Glasgow Coma Scale score of 15, an Abbreviated Injury Scale (AIS) head score from 2 to 4, and an AIS of ≤1 for non-head regions within 24 h of hospital arrival. Patients were excluded if they required an emergent neurosurgical procedure or were on a preinjury purinergic-P2 receptor-12 protein (P2Y12) inhibitor. The primary outcome was the rate of in-hospital mortality or hospice.

Results: There were 654 patients on preinjury anticoagulation who were included with a minor traumatic ICH without neurologic deficits. Overall, 263 patients were reversed and 391 were not reversed. Twelve (4.6%) patients with in-hospital mortality or hospice were reversed compared with 19 (4.91%) patients who were not reversed (p = 0.861). A composite of hospital complications occurred in 21 (8%) reversed patients and 34 (8.7%) not reversed patients (p = 0.748). The average intensive care unit length of stay was 1.4 ± 3.4 days in the reversed group and 1.1 ± 1.8 days in the not reversed group (p = 0.069).

Conclusion: This study found no difference in hospital outcomes between patients with minor traumatic ICH on oral anticoagulants who were neurologically intact that were reversed versus those who were not reversed. Further studies should continue to define the subset of traumatic ICH patients who may not require reversal of anticoagulation.

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来源期刊
Pharmacotherapy
Pharmacotherapy 医学-药学
CiteScore
7.80
自引率
2.40%
发文量
93
审稿时长
4-8 weeks
期刊介绍: Pharmacotherapy is devoted to publication of original research articles on all aspects of human pharmacology and review articles on drugs and drug therapy. The Editors and Editorial Board invite original research reports on pharmacokinetic, bioavailability, and drug interaction studies, clinical trials, investigations of specific pharmacological properties of drugs, and related topics.
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