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Emergency surgery is an effective way to improve the outcome of severe spontaneous intracerebral hemorrhage patients on long-term oral antiplatelet therapy.
Neurosurgical Review ( IF 2.8 ) Pub Date : 2020-05-29 , DOI: 10.1007/s10143-020-01319-x
Jun Wu 1, 2 , Qingyuan Liu 1, 2 , Kaiwen Wang 1, 2 , Junhua Yang 1, 2 , Pengjun Jiang 1, 2 , Maogui Li 1, 2 , Nuochuan Wang 3 , Yong Cao 1, 2 , Zeguang Ren 4 , Yanan Zhang 3 , Shuo Wang 1, 2
Affiliation  

The necessity of emergency surgery for severe spontaneous intracerebral hemorrhage (SSICH) patients on long-term oral antiplatelet therapy (LOAPT) remains unclear. The aim of this study was to investigate the effect and safety of emergency surgery for SSICH patients on LOAPT (SSICH-LOAPT patients). In this study, a retrospective review of patients admitted to our institution for SSICH from January 2012 to December 2018 was conducted. The collected data included demographic, clinical, and surgical information. The outcome was recorded at 3 months after primary hemorrhage. The outcome of SSICH-LOAPT patients receiving emergency surgery and conservative treatment were compared. The risk of postoperative intracranial bleeding (PIB) in operated SSICH-LOAPT patients was further investigated. A total of 522 SSICH patients were retrospectively reviewed, including 181 SSICH-LOAPT patients and 269 operated patients. The total mortality and in-hospital mortality were 40.6% and 19.3%, respectively. As compared with SSICH-LOAPT patients receiving conservative treatment, the operated SSICH-LOAPT patients showed a lower total (p = 0.043) and in-hospital mortality (p = 0.024). When compared with operated patients not on LOAPT, the operated patients on LOAPT exhibited a higher rate of PIB (OR, 2.34; 95% CI 1.14-4.79; p = 0.018). As demonstrated by the multivariate logistic analysis, dual antiplatelet therapy were independent risk factors associated with PIB in operated SSICH-LOAPT patients (OR, 3.42; CI, 1.01-11.51; p = 0.047). Despite of increasing risk of PIB, emergency surgery could improve the outcome of SSICH-LOAPT patients as it could be effective in reducing mortality. Dual antiplatelet therapy was the independent risk factor related to the PIB in operated SSICH-LOAPT patients.

中文翻译:

紧急手术是长期口服抗血小板治疗可改善严重自发性脑出血患者预后的有效方法。

长期口服抗血小板治疗(LOAPT)对严重自发性脑出血(SSICH)患者进行紧急手术的必要性仍不清楚。这项研究的目的是调查SSICH患者对LOAPT(SSICH-LOAPT患者)进行急诊手术的效果和安全性。在这项研究中,我们对2012年1月至2018年12月入院本院SSICH的患者进行了回顾性研究。收集的数据包括人口统计,临床和手术信息。在原发性出血3个月后记录结局。比较接受急诊手术和保守治疗的SSICH-LOAPT患者的结局。进一步调查了手术后的SSICH-LOAPT患者颅内出血(PIB)的风险。回顾性研究了522例SSICH患者,包括181名SSICH-LOAPT患者和269名手术患者。总死亡率和住院死亡率分别为40.6%和19.3%。与接受保守治疗的SSICH-LOAPT患者相比,手术后的SSICH-LOAPT患者的总死亡率(p = 0.043)和院内死亡率(p = 0.024)较低。与未接受LOAPT的手术患者相比,接受LOAPT的患者表现出更高的PIB发生率(OR为2.34; 95%CI为1.14-4.79; p = 0.018)。如多元逻辑分析所示,双重抗血小板治疗是手术SSICH-LOAPT患者与PIB相关的独立危险因素(OR,3.42; CI,1.01-11.51; p = 0.047)。尽管PIB风险增加,但紧急手术可能会有效降低死亡率,因此可以改善SSICH-LOAPT患者的预后。
更新日期:2020-05-29
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