Clinical analysis of traumatic subdural hematoma with long-term oral antiplatelet drugs

doi:10.3877/cma.j.issn.2095-9141.2020.05.004

Abstract

Abstract:

Objective

To investigate the treatment strategies and effect of acute subdural hematoma (ASDH) with long-term oral antiplatelet drugs.

Methods

Sixty seven patients with ASDH underwent surgical treatment from January 2018 to December 2018 in Neurosurgery Department of The 901^st Hospital of the Joint Logistics Support Force of PLA. Thirty two patients were treated with oral antiplatelet drugs, including 20 patients taking aspirin (aspirin-single group), 12 patients taking aspirin+clopidogrel (double antibody group), and 35 patients did not take antiplatelet drugs (control group). The preoperative coagulation indexes, intraoperative blood loss, postoperative epidural drainage flow, further hemorrhage and secondary surgery rate of 3 groups were compared and analyzed. All patients were followed up for more than 6 months, the GOS score and modified Rankin scale (mRs) score of 3 groups were compared and analyzed.

Results

Compared with control group, the bleeding time, activated partial thromboplastin time were significantly prolonged, and the intraoperative blood loss and postoperative epidural drainage flow were significantly increased in spirin-single group and double antibody group (P<0.05). Three cases (15.00%) in spirin-single group, 4 cases (33.33%) in double antibody group and 1 case (2.86%) in control group had been undergone secondary surgery dued to rehemorrhage after the first operation. After 6 months of follow-up, good recovery rate measured by GOS scores and mRs score in spirin-single group and double antibody group were significantly decreased than the control group (P<0.05).

Conclusion

Long-term oral antiplatelet drugs can aggravate the condition of ASDH, such as more bleeding and not easy to stop bleeding intraoperative, high rehemorrhage rate after operative, and hinder the neural functional recovery long-time outcome.

Key words: Craniocerebral traumatic, Acute subdural hematoma, Antiplatelet therapy

Yongming Zhang, Pengcheng Zhao, Xiaogang Wu, Zhenshan Huang, Shaonian Xu, Tao Ma. Clinical analysis of traumatic subdural hematoma with long-term oral antiplatelet drugs[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2020, 06(05): 270-274.

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References 15

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组别	例数	性别		年龄（岁）	血肿量(mL)	术前GCS评分（分）
组别	例数	男	女	年龄（岁）	血肿量(mL)	术前GCS评分（分）
单抗组	20	12	8	61.51±5.70	59.47±2.09	7.07±2.07
双抗组	12	6	6	57.43±4.32	63.19±7.48	6.07±4.31
对照组	35	18	17	59.16±2.81	56.41±9.11	7.47±3.45
F/χ²值	?	0.458		0.226	4.132	1.376
P值	?	0.795		0.315	0.197	0.245

组别	例数	性别		年龄（岁）	血肿量(mL)	术前GCS评分（分）
组别	例数	男	女	年龄（岁）	血肿量(mL)	术前GCS评分（分）
单抗组	20	12	8	61.51±5.70	59.47±2.09	7.07±2.07
双抗组	12	6	6	57.43±4.32	63.19±7.48	6.07±4.31
对照组	35	18	17	59.16±2.81	56.41±9.11	7.47±3.45
F/χ²值	?	0.458		0.226	4.132	1.376
P值	?	0.795		0.315	0.197	0.245

组别	例数	PLT(10⁹/L)	APTT(s)	INR	BT(min)
对照组	35	141.45±17.98	28.73±10.52	1.01±0.32	7.13±1.43
单抗组	20	139.12±20.39	30.43±3.31^a	1.19±0.40	11.38±2.05^a
双抗组	12	137.17±9.51	35.11±5.91^a	1.38±0.27	13.79±2.37^a
F值	?	4.378	21.073	9.367	18.345
P值	?	0.218	0.027	0.091	0.003

组别	例数	PLT(10⁹/L)	APTT(s)	INR	BT(min)
对照组	35	141.45±17.98	28.73±10.52	1.01±0.32	7.13±1.43
单抗组	20	139.12±20.39	30.43±3.31^a	1.19±0.40	11.38±2.05^a
双抗组	12	137.17±9.51	35.11±5.91^a	1.38±0.27	13.79±2.37^a
F值	?	4.378	21.073	9.367	18.345
P值	?	0.218	0.027	0.091	0.003

组别	例数	术中出血量(mL)	硬膜外引流总量(mL)	术后再出血[例(%)]	二次手术[例(%)]
对照组	35	173.26±11.39	45.07±9.08	3(8.57)	1(2.86)
单抗组	20	351.19±13.27^a	170.43±11.31^a	8(40.00)^a	3(15.00)^a
双抗组	12	478.09±9.43^ab	354.37±14.73^ab	7(58.33)^a	4(33.33)^ab
F/χ²值	?	12.435	16.119	23.415	17.002
P值	?	0.000	0.000	0.031	0.001

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