Traumatic brain injury in anticoagulated patients
Traumatic brain injury in anticoagulated patients
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DOI：
10.1097/01.ta.0000196542.54344.05
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发表时间：
2006-03-01
影响因子：
--
通讯作者：
Wilberger, JE
中科院分区：
文献类型：
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作者：
Cohen, DB;Rinker, C;Wilberger, JE
背景香豆素广泛用于老年人群。尽管它被广泛使用，但很少有人知道它对老年创伤性脑损伤患者的影响。进行这项研究，以描述这样一个cohol.Methods的结果：临床材料被确定从一级创伤中心前瞻性头部损伤数据库，并从美国外科医师学会创伤验证和审查委员会从1999年至2002年获得的数据库。两个数据库都包含许多相关变量，包括年龄、性别、格拉斯哥昏迷量表（GCS）评分、损伤机制、损伤严重程度评分、国际标准化比值（INR）、计算机断层扫描（CT）结果、手术程序、手术室时间、并发症、住院时间和出院时的结局。对于GCS评分小于8的患者，平均INR为6.0，几乎50%的初始值大于5.0。总死亡率为91.5%。对于GCS评分为13至15的77名患者，平均INR为4.4。该组的总死亡率为80.6%。尽管大多数患者的初始CT扫描正常，但一部分患者在受伤后几小时就恶化到GCS评分低于10。本组死亡率为84%。结论：所有服用华法林的患者均应进行INR检查，大多数抗凝患者应进行CT扫描。所有超治疗抗凝患者，以及任何有创伤性CT异常的抗凝患者，应入院进行神经学观察，并考虑短期逆转抗凝。强烈建议在12至18小时或甚至发生神经系统恶化的细微体征时进行常规重复CT扫描。使用这些指南的多机构前瞻性试验将是证明头部创伤后抗凝患者人群结局改善的第一步。
Background. Coumadin is widely used in the elderly population. Despite its widespread use, little is known about its effect on the outcome of elderly traumatic brain-injured patients. This study was undertaken to describe the outcomes of such a cohort.Methods: Clinical material was identified from a Level I trauma center prospective head injury database, and a database obtained from the American College of Surgeons Committee on Trauma Verification and Review Committee from 1999 to 2002. Both databases contain many relevant variables, including age, sex, Glasgow Coma Scale (GCS) score, mechanism of injury, Injury Severity Score, International Normalized Ratio (INR), computed tomography (CT) findings, operative procedure, time to operating room, complications, length of stay, and outcome at hospital discharge.Results: For patients with GCS scores less than 8, average INR was 6.0, with almost 50% having an initial value greater than 5.0. Overall mortality was 91.5%. For the 77 patients with GCS scores of 13 to 15, average INR was 4.4. Overall mortality for this group was 80.6%. A subset of patients deteriorated to a GCS score of less than 10 just hours after injury, despite most having normal initial CT scans. Mortality in this group was 84%.Conclusions: All patients on warfarin should have an INR performed, and a CT scan should be done in most anticoagulated patients. All supratherapeutically anticoagulated patients, as well as any anticoagulated patient with a traumatic CT abnormality, should be admitted for neurologic observation and consideration given to short term reversal of anticoagulation. Routine repeat CT scanning at 12 to 18 hours or when even subtle signs of neurologic worsening occur is a strong recommendation. A multi-institutional, prospective trial using these guidelines would be a first step toward demonstrating improved outcomes in the anticoagulated patient population after head trauma.