老年急诊科钝性头部创伤患者损伤前因子Xa抑制剂的疗效

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-06-10 DOI:10.1016/j.jemermed.2025.05.017

Bailey K. Pierce MD, MBA , Scott M. Alter MD, MBA , Lisa M. Clayton DO, MBS , Gabriella Engstrom PHD, RN , Mike Wells MBBCH, PHD , Joshua J. Solano MD , Patrick G. Hughes DO, MEHP , Richard D. Shih MD

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引用次数: 0

摘要

背景：直接口服抗凝剂可能会增加钝性颅脑外伤患者颅内出血和死亡率的风险。既往研究受样本量小或回顾性设计的限制。目的本研究的目的是评估直接Xa因子抑制剂与颅内出血和老年人头部外伤死亡率的关系。方法：这是一项针对钝性头部创伤的老年急诊科（ED）患者的大型队列研究的二次分析。年龄≥65岁的头部钝性创伤患者被纳入急诊科。排除标准包括使用阿哌沙班和利伐沙班以外的抗血小板或抗凝药物。通过头部计算机断层扫描和结果评估颅内出血。通过电话、医疗记录和州死亡登记处对患者进行了30天的随访。比值比比较了使用Xa因子抑制剂和未使用抗凝剂的患者颅内出血和死亡率。结果在3031例符合条件的患者中，2294例未使用抗凝或抗血小板药物，505例使用阿哌沙班，232例使用利伐沙班。在未使用抗凝治疗的患者中，162例（7.1%）发生颅内出血，46例（6.2%）使用Xa因子抑制剂发生颅内出血。Xa因子抑制剂似乎不会增加颅内出血的风险(6.2% vs. 7.1%；P = 0.443)或30天死亡率(7.9% vs. 6.8%；P = 0.345)。结论：在我们的研究中，未发现Xa因子抑制剂与老年ED合并钝性头部创伤患者颅内出血风险增加相关。需要进一步的研究来证实我们的发现。

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Outcomes in Geriatric Emergency Department Patients with Blunt Head Trauma on Preinjury Factor Xa Inhibitors

Background

Direct oral anticoagulants may increase the risk of intracranial hemorrhage and mortality in patients with blunt head trauma. Previous studies are limited by small sample size or retrospective design.

Objective

The objective of this study was to evaluate the association of direct factor Xa inhibitors on intracranial hemorrhage and mortality in older adults with head trauma.

Methods

This is a secondary analysis of a large cohort study of geriatric emergency department (ED) patients with blunt head trauma. Patients ≥ 65 years presenting to the ED with blunt head trauma were included. Exclusion criteria included use of antiplatelet or anticoagulant medications other than apixaban and rivaroxaban. Intracranial hemorrhage was assessed via head computed tomography and outcomes. Patients were followed up for 30 days via telephone, medical records, and the state death registry. Odds ratios compared intracranial hemorrhage and mortality rates in patients on factor Xa inhibitors with those not anticoagulated.

Results

Of 3031 eligible patients, 2294 were not on anticoagulant or antiplatelet agent, 505 were on apixaban, and 232 on rivaroxaban. Among those not on anticoagulation, 162 patients (7.1%) developed intracranial hemorrhage and 46 patients (6.2%) on factor Xa inhibitors experienced intracranial hemorrhage. Factor Xa inhibitors do not seem to increase the risk of intracranial hemorrhage (6.2% vs. 7.1%; p = 0.443) or 30-day mortality (7.9% vs. 6.8%; p = 0.345).

Conclusions

Factor Xa inhibitors were not found to be associated with an increased risk of intracranial hemorrhage in geriatric ED patients with blunt head trauma in our study. Additional studies need to be completed to confirm our findings.

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine