术前使用低剂量阿司匹林对老年人创伤性颅内出血急诊手术结局的影响
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Preoperative Low-Dose Aspirin Exposure and Outcomes After Emergency Neurosurgery for Traumatic Intracranial Hemorrhage in Elderly Patients
背景与目的
抗血小板药物通常在择期神经外科手术前停药，但急诊神经外科手术的没有这种选择。 我们进行了回顾性队列研究，以调查术前阿司匹林使用是否与老年人急诊神经外科手术后糟糕的结果相关。
方 法
我们分析了2008年至2012年1级创伤中心的所有创伤性颅内出血急诊神经外科手术病例。通过统计学，比较术前服用阿司匹林的老年人（＞65岁）带来的合并症和影响。排除标准为：（1）多发性破裂（2）伴随使用其他术前抗凝剂或抗血小板药物（3）除硬膜下，硬膜外或实质内出血以外的手术指征（4）单次入院时重复神经外科手术。研究项目包括：术中失血量，术后48小时内失血量，术后颅内出血需要重新手术几率，院内死亡率，ICU留住时间，围术期血制品使用率。我们还调查了血小板输注是否对服用阿司匹林的患者的结局有影响。
结 果
研究包括171例。接受术前阿司匹林的患者（n = 87,95％，服用81毫克/天）与不服用阿司匹林的患者的年龄相同（n = 84; 78.3±7.8比75.9±7.9岁，P> 0.05），格拉斯哥昏迷量表评分略高（12.8±3.4 vs11.4±4，P =0.02），往往有更多的冠状动脉疾病（P <0.05）。术前接受阿司匹林的患者围手术期血小板输注的可能性较高（调整后的比值比为9.89,95％置信区间，4.24〜26.25）。两组之间的其他结果没有差异。 术前或术中血小板输注与阿司匹林患者的结局无关。
结 论
年龄≥65岁的患者经历急诊神经外科手术后，术前低剂量阿司匹林治疗与术中出血，术后出血，住院时间或住院死亡率无关。
原始文献摘要
Lee A T, Gagnidze A, Pan S R, et al. Preoperative Low-Dose Aspirin Exposure and Outcomes After Emergency Neurosurgery for Traumatic Intracranial Hemorrhage in Elderly Patients.[J]. Anesthesia & Analgesia, 2017.
Background: Antiplatelet medications are usually discontinued before elective neurosurgery,but this is not an option for emergent neurosurgery. We performed a retrospective cohort study to examine whether preoperative aspirin use was associated with worse outcomes after emergency neurosurgery in elderly patients
Methods: We analyzed all cases of emergency neurosurgical procedures for traumatic intracranial hemorrhage from 2008 to 2012 at a level 1 trauma center. Demographics, comorbidities, and outcomes were compared for patients≥65 years by preoperative aspirin exposure. Exclusion criteria were: (1) polytrauma, (2) concomitant use of other preoperative anticoagulants or antiplatelet agents, (3) surgical indication other than subdural, extradural, or intraparenchymal hemorrhage, and (4) repeat neurosurgical procedures within a single admission. Estimated intraoperative blood loss, postprocedural intracranial bleeding requiring reoperation, death in hospital, intensive care unit, and hospital lengths of stay and perioperative blood product transfusion from 48 hours before 48 hours after surgery were the study outcomes. We also examined whether platelet transfusion had an impact on outcomes for patients on aspirin.
Results: The cohort included 171 patients. Patients receiving preoperative aspirin (n = 87, 95% taking 81 mg/day) were the same age as patients not receiving aspirin (n = 84; 78.3 ± 7.8 vs 75.9± 7.9 years, P > .05), had slightly higher admission Glasgow Coma Scale scores (12.8 ± 3.4 vs11.4 ± 4, P = .02) and tended to have more coronary artery disease (P < .05). Adjusted for Glasgow Coma Scale and coronary artery disease, patients receiving preoperative aspirin had a higher odds of perioperative platelet transfusion (adjusted odds ratio 9.89, 95% confidence interval, 4.24–26.25). There were no other differences in outcomes between the 2 groups. Preoperative or intraoperative platelet transfusion was not associated with better outcomes among aspirin patients.
Conclusions: In patients age ≥65 years undergoing emergency neurosurgery for traumatic intracranial hemorrhage, preoperative low-dose aspirin treatment was not associated with increased perioperative bleeding, hospital lengths of stay, or in-hospital mortality.
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