A Systematic Review of the Benefits and Risks of Anticoagulation Following Traumatic Brain Injury.
A Systematic Review of the Benefits and Risks of Anticoagulation Following Traumatic Brain Injury.
复制标题
创伤性脑损伤后抗凝治疗的益处和风险的系统评价。
DOI：
10.1097/htr.0000000000000077
复制
发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Zuckerman,IleneH
中科院分区：
文献类型：
--
作者：
Shen,Xian;Dutcher,SarahK;Palmer,Jacqueline;Liu,Xinggang;Kiptanui,Zippora;Khokhar,Bilal;Al-Jawadi,MohammadH;Zhu,Yue;Zuckerman,IleneH
目的：综合现有文献对创伤性脑损伤（TBI）后使用抗凝血剂的益处和风险进行分析。设计:系统回顾。文献检索于2012年10月11日在MEDLINE、International Pharmaceutical Abstracts、Health Star和CINAHL（护理和相关健康文献累积索引）中进行，并于2013年9月2日更新，检索与TBI和抗凝血剂相关的术语。主要指标：评价脑外伤后抗凝对静脉血栓栓塞、出血、死亡率或凝血参数影响的人类研究具有原始分析的资格。在整个审查过程中遵循PRISMA（系统评价和荟萃分析首选报告项目）指南。结果：从文献中确定了39项符合条件的研究，其中23项研究在tbi后抗凝使用和患者结局方面具有完整的信息。由于研究的方法设计和质量不同，荟萃分析是不合理的。21项研究集中在tbi后药物血栓预防（PTP）对静脉血栓栓塞和/或颅内出血进展的影响，而2项随机对照试验分析了抗凝治疗结果的凝血参数。结论：对于出血模式稳定的TBI患者，药物血栓预防似乎是安全的。关于PTP预防静脉血栓栓塞的有效性，以及PTP的首选药物、剂量和时间，还需要更多的证据。
Objective:To synthesize the existing literature on benefits and risks of anticoagulant use after traumatic brain injury (TBI).Design:Systematic review. A literature search was performed in MEDLINE, International Pharmaceutical Abstracts, Health Star, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) on October 11, 2012, and updated on September 2, 2013, using terms related to TBI and anticoagulants.Main Measures:Human studies evaluating the effects of post-TBI anticoagulation on venous thromboembolism, hemorrhage, mortality, or coagulation parameters with original analyses were eligible for the review. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was followed throughout the conduct of the review.Results:Thirty-nine eligible studies were identified from the literature, of which 23 studies with complete information on post-TBI anticoagulant use and patient outcomes were summarized in this review. Meta-analysis was unwarranted because of varying methodological design and quality of the studies. Twenty-one studies focused on the effects of pharmacological thromboprophylaxis (PTP) post-TBI on venous thromboembolism and/or progression of intracranial hemorrhage, whereas 2 randomized controlled trials analyzed coagulation parameters as the result of anticoagulation.Conclusion:Pharmacological thromboprophylaxis appears to be safe among TBI patients with stabilized hemorrhagic patterns. More evidence is needed regarding effectiveness of PTP in preventing venous thromboembolism as well as preferred agent, dose, and timing for PTP.