Restarting and timing of oral anticoagulation after traumatic intracranial hemorrhage: a review and summary of ongoing and planned prospective randomized clinical trials.
Restarting and timing of oral anticoagulation after traumatic intracranial hemorrhage: a review and summary of ongoing and planned prospective randomized clinical trials.
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DOI：
10.1136/tsaco-2020-000605
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发表时间：
2020
影响因子：
2
通讯作者：
Warach S
中科院分区：
文献类型：
--
作者：
King B;Milling T;Gajewski B;Costantini TW;Wick J;Price MA;Mudaranthakam D;Stein DM;Connolly S;Valadka A;Warach S
抗凝剂相关性外伤性颅内出血(TICrH)是一种高发病率、高死亡率的破坏性损伤。对于幸存者来说，治疗临床医生面临着在缺乏证据指导的情况下重新开始口服抗凝的两难境地。血栓栓塞症的风险来自出血事件，患者的高基线风险，即先前存在的抗凝适应症，以及出血事件后不能动的风险。这必须与潜在的破坏性血肿扩大或新的出血性病变相平衡。回顾性证据和专家意见支持在大多数tICrH患者中重新使用口服抗凝药物，但时机尚不确定。研究人员未能明确区分TICRH和自发性颅内出血(SICRH)，这两种疾病有着不同的自然病史。虽然两者似乎都从重新启动中受益，但SICRH有更高的再出血风险和相似或更低的血栓风险。重新启动的临床平衡也存在分歧。在SICRH，均衡的核心是是否重启。在tICrH中，它以时间为中心。几项前瞻性随机临床试验正在进行或即将开始，以检查重新启动的风险和好处。其中大多数仅限于SICRH患者，并有抗血小板对照组。大多数也被限制为直接口服抗凝剂(DOAC)，因为它们与ICrH的总体风险较低有关。通过硬膜下血肿与tICrH有一些重叠，其中一项试验专门针对仅在创伤性病例中使用DOAC重新开始计时。本文对TICrH后重新启动抗凝和重新启动时机的现有证据进行了叙述性回顾，并对正在进行和计划中的临床试验进行了总结。
Anticoagulant-associated traumatic intracranial hemorrhage (tICrH) is a devastating injury with high morbidity and mortality. For survivors, treating clinicians face the dilemma of restarting oral anticoagulation with scarce evidence to guide them. Thromboembolic risk is high from the bleeding event, patients’ high baseline risks, that is, the pre-existing indication for anticoagulation, and the risk of immobility after the bleeding episode. This must be balanced with potentially devastating hematoma expansion or new hemorrhagic lesions. Retrospective evidence and expert opinion support restarting oral anticoagulants in most patients with tICrH, but timing is uncertain. Researchers have failed to make clear distinctions between tICrH and spontaneous intracranial hemorrhage (sICrH), which have differing natural histories. While both appear to benefit from restarting, sICrH has a higher rebleeding risk and similar or lower thrombotic risk. Clinical equipoise on restarting is also divergent. In sICrH, equipoise is centered on whether to restart. In tICrH, it is centered on when. Several prospective randomized clinical trials are ongoing or about to start to examine the risk–benefit of restarting. Most of them are restricted to patients with sICrH, with antiplatelet control groups. Most are also restricted to direct oral anticoagulants (DOACs), as they are associated with a lower overall risk of ICrH. There is some overlap with tICrH via subdural hematoma, and one trial is specific to restart timing with DOACs in only traumatic cases. This is a narrative review of the current evidence for restarting anticoagulation and restart timing after tICrH along with a summary of the ongoing and planned clinical trials.
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影响因子：
8.3
作者：
Majeed, Ammar;Kim, Yang-Ki;Schulman, Sam
通讯作者：
Schulman, Sam
DOI：
10.1186/1749-7922-7-25
发表时间：
2012-07-23
期刊：
World journal of emergency surgery : WJES
影响因子：
--
作者：
Byrnes MC;Irwin E;Roach R;James M;Horst PK;Reicks P
通讯作者：
Reicks P
影响因子：
4.8
作者：
Gage, BF;Yan, Y;Radford, MJ
通讯作者：
Radford, MJ
影响因子：
158.5
作者：
Connolly, S. J.;Crowther, M.;Milling, T. J., Jr.
通讯作者：
Milling, T. J., Jr.
影响因子：
2.6
作者：
Chiu, Alexander S.;Jean, Raymond A.;Pei, Kevin Y.
通讯作者：
Pei, Kevin Y.