抗血小板薬あるいは抗凝固薬服用者の外傷性急性硬膜下血腫の検討

抄録

Objective. To investigate the cause of poor prognosis of traumatic acute subdural hematoma (TaSDH) in patients on pre-injury antiplatelets and/or anticoagulants (antithrombotic agents), we retrospectively reviewed our own cases.

Materials and Methods. From 2001 to 2011, we managed 7 surgically treated patients with TaSDH on pre-injury anti­thrombotic agents (antithrombotic group) and 63 without antithrombotic agents (non antithrombotic group). Age and gender of the patients, the mechanisms of injury, cause of antithrombotic agents on antithrombotic group, post­operative clinical course and outcomes were analyzed.

Results. On antithrombotic group, 6 were male, 1 female. The average age of injury was 77.6 years. Warfarin was prescribed in 3 cases for atrial fibrillation and in 1 for deep venous thrombosis, combination of warfarin and aspirin prescribed in 2 for myocardial infarction, ticlopidine in 1 for MI. The mechanisms of injury included involvement of traffic accident in 3 cases, fall downstairs in 3 and fall on the road in 1. Decompressive craniectomy, evacuation of hematoma, placement of external ventricular drainage and intracranial pressure monitoring and normothermia were carried out on acute stage. Outcomes at discharge were severely disabled in 3 cases, persistent vegetative status in 1 and dead in 2. Compared with the cases on non anti­thrombotic group, patient's age was significantly higher than that on nonantithrombotic group (77 years old vs. 63 years old; p<0.05).

Conclusions. Patients with TaSDH on pre-injury anti­thrombotic agents have older age and poorer outcomes than those without antithrombotic agents. Physicians should beware of prescribing antithrombotic agents for elderly patients to avoid excessive primary hemorrhagic cause.