Therapeutic anticoagulation can be safely accomplished in selected patients with traumatic intracranial hemorrhage.
Therapeutic anticoagulation can be safely accomplished in selected patients with traumatic intracranial hemorrhage.
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DOI：
10.1186/1749-7922-7-25
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发表时间：
2012-07-23
期刊：
影响因子：
--
通讯作者：
Reicks P
中科院分区：
文献类型：
--
作者：
Byrnes MC;Irwin E;Roach R;James M;Horst PK;Reicks P
治疗性抗凝是血栓栓塞并发症（如DVT、PE和钝性脑血管损伤）的重要治疗方法。创伤性颅内出血传统上被认为是抗凝治疗的禁忌症。治疗性抗凝可以安全地完成在选定的患者外伤性颅内出血。根据治疗模式对发生DVT、PE或钝性脑血管损伤血栓栓塞并发症的患者进行分层。通过CT扫描评价接受肝素输注或依诺肝素（1 mg/kg BID）抗凝治疗的患者的神经功能恶化或出血扩展。有42名患者发生了创伤性颅内出血，随后发生了血栓性并发症。35例患者发生DVT或PE。4例患者诊断为钝性脑血管损伤。26例患者接受了抗凝治疗，平均在伤后13天开始。开始抗凝治疗后，96%的患者出血没有扩大。其余患者的出血扩展程度极轻微，感觉不影响临床病程。治疗性抗凝可以在颅内出血的患者中完成，尽管需要连续CT扫描密切监测以证明出血灶的稳定性。
Therapeutic anticoagulation is an important treatment of thromboembolic complications, such as DVT, PE, and blunt cerebrovascular injury. Traumatic intracranial hemorrhage has traditionally been considered to be a contraindication to anticoagulation. Therapeutic anticoagulation can be safely accomplished in select patients with traumatic intracranial hemorrhage. Patients who developed thromboembolic complications of DVT, PE, or blunt cerebrovascular injury were stratified according to mode of treatment. Patients who underwent therapeutic anticoagulation with a heparin infusion or enoxaparin (1 mg/kg BID) were evaluated for neurologic deterioration or hemorrhage extension by CT scan. There were 42 patients with a traumatic intracranial hemorrhage that subsequently developed a thrombotic complication. Thirty-five patients developed a DVT or PE. Blunt cerebrovascular injury was diagnosed in four patients. 26 patients received therapeutic anticoagulation, which was initiated an average of 13 days after injury. 96% of patients had no extension of the hemorrhage after anticoagulation was started. The degree of hemorrhagic extension in the remaining patient was minimal and was not felt to affect the clinical course. Therapeutic anticoagulation can be accomplished in select patients with intracranial hemorrhage, although close monitoring with serial CT scans is necessary to demonstrate stability of the hemorrhagic focus.
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