原著
抗血栓薬内服中の急性硬膜下血腫患者の臨床的特徴：単一施設における後方視的解析
2021 年 44 巻 1 号 p. 1-7
詳細
2021 年 44 巻 1 号 p. 1-7
Background: Elderly patients with traumatic brain injury (TBI) are increasingly common in Japan. The number of patients taking antithrombotics is also increasing due to the aging population. Generally, the clinical outcomes of TBI patients with antithrombotic therapy are poor. Thus, revealing the clinical characteristics of TBI with antithrombotic therapy is required. This study investigated clinical characteristics and prognostic factors of acute subdural hematoma (ASDH) with antithrombotic therapy.
Methods: The clinical data of 88 consecutive ASDH patients were retrospectively reviewed. Patients were divided into two groups, antithrombotics (–) group and antithrombotics (+) group. Age, sex, mechanisms of injury, Glasgow coma scale score (GCS score) on admission, types of hematoma, surgery, Glasgow outcome scale (GOS) at discharge and time from onset to admission were analyzed by univariate and multivariate analysis.
Results: Twenty–five patients (28.4%) took antithrombotics. Fall injuries were most common mechanism of injury (61 of 88 cases, 69.3%). 23 patients (26.1%) were severe brain injury (GCS score ≦ 8 on admission), 16 patients (18.2%) developed talk and deteriorate and 27 patients (30.7%) underwent surgeries. Only GCS score ≦ 8 on admission was associated with poor outcome defined by vegetative state or dead at discharge.
Compared with antithrombotics (–) group, antithrombotics (+) group was significantly older (82 years versus 73 years, p<0.05) and fall related injuries were more common. In antithrombotics (+) group, 52.0% of patients (13 of 25 cases) admitted hospital over 6 hours from onset. Among patients admitted hospital within 3 hours from onset, poor clinical outcome was comparable between antithrombotics (+) and (–) group (41.7% [5 of 12 cases] versus 40.4% [18 of 45 cases]). Although, among patients admitted hospital over 3 hours from onset, poor clinical outcome was more common in antithrombotics (+) group (38.5% [5 of 13 cases] versus 20.0% [4 of 20 cases]).
Conclusion: Only GCS score on admission was significantly associated with poor outcome of ASDH. ASDH patients with antithrombotic therapy are characterized by fall related injury of elderly people, tend to get severe due to delay in admission. Early diagnosis and adequate intervention are required.
