Choosing the Best Approach to Warfarin Reversal After Traumatic Intracranial Hemorrhage.
Choosing the Best Approach to Warfarin Reversal After Traumatic Intracranial Hemorrhage.
复制标题
选择外伤性颅内出血后华法林逆转的最佳方法。
DOI：
10.1016/j.jss.2020.12.004
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Schuster,KevinM
中科院分区：
文献类型：
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作者：
Lumas,ShunellaG;Hsiang,Walter;Becher,RobertD;Maung,AdrianA;Davis,KimberlyA;Schuster,KevinM
背景：外伤性颅内出血患者服用华法林后，华法林的作用常常逆转。我们比较了患者谁收到4-因子凝血酶原复合物浓缩物（PCC），新鲜冷冻血浆（FFP），或没有逆转，以评估现实世界的影响PCC对老年患者外伤性颅内出血（ICH）的结果historicandmethodsThis是一个回顾性分析150例患者损伤前华法林。数据是从2013年1月至2018年12月期间入院的1级创伤中心的电子病历中手动提取的。结果是ICH进展后续计算机断层扫描，死亡率，需要手术干预，并在使用reversible agents.ResultsOf 150例患者符合分析的趋势，41接受FFP，60 PCC，和49没有逆转。在多变量分析中，未逆转的患者[OR 0.25 95% CI（0.31-0.85）]和女性患者[OR 0.38 95% CI（0.17-0.88）]在随访计算机断层扫描中发生首次出血进展的可能性较小，而硬膜下出血增加了风险[OR 3.69 95% CI（1.27-10.73）]。在死亡率或手术需求方面，两组之间没有差异。随着时间的推移，使用PCC逆转增加，而使用FFP和不逆转华法林下降（P< 0.001）。逆转的选择不影响手术的需要、住院时间或死亡率。一些ICH患者可能不需要华法林逆转，并且可能偏倚研究，特别是华法林逆转的回顾性研究。
BackgroundPatients on warfarin with traumatic intracranial hemorrhage often have the warfarin effects pharmacologically reversed. We compared outcomes among patients who received 4-factor prothrombin complex concentrate (PCC), fresh frozen plasma (FFP), or no reversal to assess the real-world impact of PCC on elderly patients with traumatic intracranial hemorrhage (ICH).Materials and MethodsThis was a retrospective analysis of 150 patients on preinjury warfarin. Data were manually abstracted from the electronic medical record of an academic level 1 trauma center for patients admitted between January 2013 and December 2018. Outcomes were ICH progression on follow-up computed tomography scan, mortality, need for surgical intervention, and trends in the use of reversal agents.ResultsOf 150 patients eligible for analysis, 41 received FFP, 60 PCC, and 49 were not reversed. On multivariable analysis, patients not reversed [OR 0.25 95% CI (0.31-0.85)] and women [OR 0.38 95% CI (0.17-0.88)] were less likely to experience progression of their initial bleed on follow-up computed tomography while subdural hemorrhage increased the risk [OR 3.69 95% CI (1.27-10.73)]. There was no difference between groups in terms of mortality or need for surgery. Over time use of reversal with PCC increased while use of FFP and not reversing warfarin declined (P< 0.001).ConclusionsMale gender and using a reversal agent were associated with progression of ICH. Choice of reversal did not impact the need for surgery, hospital length of stay, or mortality. Some ICH patients may not require warfarin reversal and may bias studies, especially retrospective studies of warfarin reversal.