Antithrombotic therapy and outcomes of cervical arterial dissection in the trauma patient: a case series.
Antithrombotic therapy and outcomes of cervical arterial dissection in the trauma patient: a case series.
复制标题
DOI：
10.1186/1752-2897-4-13
复制
发表时间：
2010-12-13
期刊：
影响因子：
--
通讯作者：
Cole, John W
中科院分区：
文献类型：
--
作者：
Hinson, Holly E;Stallmeyer, M Jb;Cole, John W
背景：在创伤性颈动脉夹层（CAD）的情况下使用抗血栓治疗（抗凝剂和/或抗血小板）来预防中风仍然存在争议。由于颅内出血（ICH）和其他颅内损伤经常并存，而且由于缺乏循证指导，治疗方法存在很大差异，使这个问题变得更加复杂。为了解决这些争议，在一个主要的一级创伤中心创建了一个登记处。本研究的目的是比较创伤后 CAD 抗血栓治疗的安全性。提供了第一年的分析。方法：2005 年以来的所有宫颈解剖都是根据放射学和创伤数据库中的诊断代码在年满 18 岁的患者中进行识别的。动脉损伤的存在和分级，以及其他颅内疾病或损伤（如中风）由创伤放射科医生诊断，并由神经放射科医生判定。结果：确定了 55 名颈动脉夹层患者。 14 名患者总共出现 20 次急性外伤后颅内出血 (ICH)。 14 例 ICH 患者中，7 例接受了抗栓治疗，无一例颅内出血扩大。在 41 名既往没有 ICH 的患者中，28 名患者接受了抗血栓治疗，只有 1 名患者出现间歇性血肿。在所有 55 例病例中，两名患者入院后在解剖动脉区域发生急性缺血性卒中；结论：就抗血栓治疗可能有助于预防颈动脉夹层术后早期缺血性卒中而言，这些数据表明，即使在颅内出血的情况下，也可能不需要在创伤后停用抗血小板药物或其他抗血栓药物。从安全角度来看，这个基于登记的病例系列表明，动脉损伤的抗血栓治疗不会导致脑出血的发生或进展，即使对于既往存在脑出血的患者也是如此。该数据表明，在创伤性颈椎清扫术患者中，早期进行抗血栓治疗可降低脑出血或出血范围的风险。
BACKGROUND: The use of antithrombotic therapy (anticoagulants and/or antiplatelets) in the setting of traumatic cervical arterial dissection (CAD) for the prevention of stroke remains controversial. This issue is further complicated by the frequent co-existence of intracranial hemorrhage (ICH) and other intracranial injuries, and also the wide variability in treatment due to a lack of evidence-based guidance. To address these controversies, a registry in a major Level I trauma center was created. The purpose of this investigation was to compare the safety of antithrombotic therapy in post-traumatic CAD. Analysis from the first year is presented.METHODS: All cervical dissections from the year 2005 were identified in patients at least 18 years of age by diagnosis code from radiology and trauma databases. Presence of arterial injury and grade, and other intracranial disease or injury such as stroke was diagnosed by a trauma radiologist and adjudicated by a neuroradiologist.RESULTS: Fifty-five patients with cervical artery dissection were identified. Fourteen patients presented with a total of 20 acute, post-traumatic intracranial hemorrhages (ICH). Seven of the 14 patients with ICH were treated with antithrombotic therapy, and none extended their intracranial hemorrhages. Of the 41 patients without pre-existing ICH, 28 were treated with antithrombotic therapy and only one developed an interval hematoma. Among all 55 cases, two patients developed an acute ischemic stroke in the territory of the dissected artery after admission; both patients were in the untreated group.CONCLUSION: In so far as antithrombotic therapy may offer benefit in preventing early ischemic stroke following cervical artery dissection, these data suggest withholding antiplatelet or other antithrombotics following trauma may not be warranted, even in the setting of intracranial hemorrhage. From a safety perspective, this registry-based case series indicates antithrombotic management of arterial injury did not contribute to development or progression of ICH, even in patients with pre-existing ICH. This data suggest that instituting early antithrombotic therapy presents a low risk of ICH or hemorrhage extension among traumatic cervical dissection patients.