抗血栓药物对老年非创伤性慢性硬膜下血肿的影响
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摘要
目的:探讨抗血栓药物对老年非创伤性慢性硬膜下血肿的影响。方法:分析我院自2009年8月—2014年8月收进并在局麻或局麻+强化下行颅骨钻孔引流术的53例65岁以上非创伤性慢性硬膜下血肿患者。长期口服抗血栓药物患者36例,其中7例患者服用新型抗血栓药物,未服用抗血栓药物患者17例。收集所有患者的性别、年龄、服用抗血栓药物史、临床症状、影像学表现、治疗方法等相关资料,比较服用抗血栓药物患者和未服用抗血栓药物患者住院期间治疗情况;术后随访3年,观察两组复发率。结果:53例老年非创伤性慢性硬膜下血肿患者均手术治愈,术后随访3年期间复发6例,未服用抗血栓药物组1例,服用抗血栓药物组5例,服用新型抗血栓药物的7例患者没有复发。复发患者再次手术治疗后均好转。结论:服用抗血栓药物不是老年非创伤性慢性硬膜下血肿手术绝对禁忌,服用抗血栓药物可增加老年非创伤性慢性硬膜下血肿患病和复发机率,新型抗血栓药物是否使患者不再复发仍值得探讨。
Objective: To investigate the effects of antithrombotic drugs on non-traumatic chronic subdural hematoma in the elderly patients. Methods: We analyzed 53 patients with non-traumatic chronic subdural hematoma over 65 years of age who were admitted to our hospital from August 2009 to August 2014 and were under local anesthesia or local anesthesia + enhanced burr hole drainage. There were 36 patients who had long-term oral antithrombotic drugs,and among them,7 patients took new antithrombotic drugs,17 patients who did not take antithrombotic drugs. All the patients' sex,age,history of use antithrombotic drugs,clinical symptoms,clinical imaging data,treatment methods,and other relevant data were collected. The patients in the antithrombotic group and the non-thrombolytic group were compared during the hospitalization period. After 3 years of follow-up,the recurrence rate was observed. Results: 53 patients with non-traumatic chronic subdural hematoma were cured,6 patients relapsed after 3 years of follow-up. 1 patient who did not take antithrombotic drugs and 5 patients who took antithrombotic drugs. 7 patients taking the new antithrombotic drug did not relapse. Relapsed patients were cured after reoperation. Conclusion: The use of antithrombotic drugs is not an absolute contraindication for elderly non-traumatic chronic subdural hematoma surgery. Taking antithrombotic drugs increases the risk of non-traumatic chronic subdural hematoma in the elderly and the probability of recurrence. It is worth exploring whether new anticoagulant drugs may benefit patients in terms of recurrence.
Objective: To investigate the effects of antithrombotic drugs on non-traumatic chronic subdural hematoma in the elderly patients. Methods: We analyzed 53 patients with non-traumatic chronic subdural hematoma over 65 years of age who were admitted to our hospital from August 2009 to August 2014 and were under local anesthesia or local anesthesia + enhanced burr hole drainage. There were 36 patients who had long-term oral antithrombotic drugs,and among them,7 patients took new antithrombotic drugs,17 patients who did not take antithrombotic drugs. All the patients' sex,age,history of use antithrombotic drugs,clinical symptoms,clinical imaging data,treatment methods,and other relevant data were collected. The patients in the antithrombotic group and the non-thrombolytic group were compared during the hospitalization period. After 3 years of follow-up,the recurrence rate was observed. Results: 53 patients with non-traumatic chronic subdural hematoma were cured,6 patients relapsed after 3 years of follow-up. 1 patient who did not take antithrombotic drugs and 5 patients who took antithrombotic drugs. 7 patients taking the new antithrombotic drug did not relapse. Relapsed patients were cured after reoperation. Conclusion: The use of antithrombotic drugs is not an absolute contraindication for elderly non-traumatic chronic subdural hematoma surgery. Taking antithrombotic drugs increases the risk of non-traumatic chronic subdural hematoma in the elderly and the probability of recurrence. It is worth exploring whether new anticoagulant drugs may benefit patients in terms of recurrence.
引文
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[5] FORNEBO I,SJAVIK K,ALIBECK M,et al. Role of antithrombotic therapy in the risk of hematoma recurrence and thromboembolism after chronic subdural hematoma evacuation:a populationbased consecutive cohort study[J]. Acta Neurochir(Wien),2017,159(11):2045-2052.
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[8] LINDVALL P,KOSKINEN L. Anticoagulants and anti-platelet agents and the risk of development and recurrence of chronic subdural haematomas[J]. J Clin Neurosci,2009,16(10):1287-1290.
[9] ANDREW F,DUCRUET T,GROBELNY E. The surgical management of chronic subdural hematoma[J]. Neurosurg Rev,2011,35(2):155-169.
[10] SURYANARAYANA SPM,TEKKATTE JA,JAVALI M,et al.Spontaneous subdural hematoma and antiplatelet therapy:does efficacy of Ticagrelor come with added risk?[J]. Indian Heart J,2015,67(Suppl 3):S30-S35.
[11] FORSTER M,MATHE A,SENFT C,et al. The influence of preoperative anticoagulation on outcome and quality of life after surgical treatment of chronic sundural hematoma[J]. J Clin Neurosci,2010,17(8):975-979.
[12] TORIHASHI K,SADAMASA N,YOSHIDA K,et al. Independent predictors for recurrence of chronic subdural hematoma:a review of 343 consecutive surgical cases[J]. Neurosurgery,2008,63(6):1125-1129.
[13] KIM SU,LEE DH,KIM YI,et al. Predictive factors for recurrence after burr-hole craniostomy of chronic subdural hematoma[J]. J Korean Neurosurg Soc,2017,60(6):701-709.
[14] GONUGUNTA V,BUXTON N. Warfarin and chronic subdural haematomas[J]. Br J Neurosurg,2001,15(6):514-517.
[15] KAWAMATA T,TAKESHITA M,KUBO O,et al. Management of intracranial hemorrhage associated with anticoagulant therapy[J]. Surg Neurol,1995,44(5):438-443.
[16] GUHA D,COYNE S,MACDONALD RL. Timing of the resumption of antithrombotic agents following surgical evacuation of chronic subdural hematomas:a retrospective cohort study[J]. J Neurosurg,2016,124(3):750-759.
[17] OKANO A,OYA S,FUJISAWA N,et al. Analysis of risk factors for chronic subdural haematoma recurrence after burr hole surgery:optimal management of patients on antiplatelet therapy[J]. Br J Neurosurg,2014,28(1):204-208.
[2] NAKAGUCHI H,TANISHIMA T,YOSHIMASU N. Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence[J]. Neurosurgery,2001,95(2):256-262.
[3] COUSSEAU D,GASPARI M,GONORAZKY S. Chronic and subacute subdural haematoma. An epidemiological study in a captive population[J]. Rev Neurol,2001,32(9):821-824.
[4]张敏,李慧,段慧玲.老年慢性硬膜下血肿的病因、临床特征和影响预后因素[J].中国实用神经疾病杂志,2010,13(5):55-56.
[5] FORNEBO I,SJAVIK K,ALIBECK M,et al. Role of antithrombotic therapy in the risk of hematoma recurrence and thromboembolism after chronic subdural hematoma evacuation:a populationbased consecutive cohort study[J]. Acta Neurochir(Wien),2017,159(11):2045-2052.
[6] RUST T,KIEMER N,ERASMUS A. Chronic subdural haematomas and anticoagulation or anti-thrombotic therapy[J]. J Clin Neurosci,2006,13(8):823-827.
[7] BAECHLI H,NORDMANN A,BUCHER HC,et al. Demographics and prevalent risk factors of chronic subdural haematoma:results of a large single-center cohort study[J]. Neurosurg Rev,2004,27(4):263-266.
[8] LINDVALL P,KOSKINEN L. Anticoagulants and anti-platelet agents and the risk of development and recurrence of chronic subdural haematomas[J]. J Clin Neurosci,2009,16(10):1287-1290.
[9] ANDREW F,DUCRUET T,GROBELNY E. The surgical management of chronic subdural hematoma[J]. Neurosurg Rev,2011,35(2):155-169.
[10] SURYANARAYANA SPM,TEKKATTE JA,JAVALI M,et al.Spontaneous subdural hematoma and antiplatelet therapy:does efficacy of Ticagrelor come with added risk?[J]. Indian Heart J,2015,67(Suppl 3):S30-S35.
[11] FORSTER M,MATHE A,SENFT C,et al. The influence of preoperative anticoagulation on outcome and quality of life after surgical treatment of chronic sundural hematoma[J]. J Clin Neurosci,2010,17(8):975-979.
[12] TORIHASHI K,SADAMASA N,YOSHIDA K,et al. Independent predictors for recurrence of chronic subdural hematoma:a review of 343 consecutive surgical cases[J]. Neurosurgery,2008,63(6):1125-1129.
[13] KIM SU,LEE DH,KIM YI,et al. Predictive factors for recurrence after burr-hole craniostomy of chronic subdural hematoma[J]. J Korean Neurosurg Soc,2017,60(6):701-709.
[14] GONUGUNTA V,BUXTON N. Warfarin and chronic subdural haematomas[J]. Br J Neurosurg,2001,15(6):514-517.
[15] KAWAMATA T,TAKESHITA M,KUBO O,et al. Management of intracranial hemorrhage associated with anticoagulant therapy[J]. Surg Neurol,1995,44(5):438-443.
[16] GUHA D,COYNE S,MACDONALD RL. Timing of the resumption of antithrombotic agents following surgical evacuation of chronic subdural hematomas:a retrospective cohort study[J]. J Neurosurg,2016,124(3):750-759.
[17] OKANO A,OYA S,FUJISAWA N,et al. Analysis of risk factors for chronic subdural haematoma recurrence after burr hole surgery:optimal management of patients on antiplatelet therapy[J]. Br J Neurosurg,2014,28(1):204-208.