背景:钝性脑血管损伤(BCVI)发生在1-3%的钝性创伤中,并与中风有关,残疾,和死亡率,如果不承认和未经治疗。早期发现和治疗是降低中风风险的当务之急,然而,在所使用的特定医疗管理策略中,中心和创伤护理提供者之间存在显著差异.这项研究比较了抗血小板与确定BCVI相关卒中风险和出血并发症的抗凝剂,以更好地了解各种治疗策略的有效性和安全性。
方法:对MEDLINE,Embase,CochraneCENTRAL数据库是在医学图书馆员的协助下进行的。通过对文献的手动审查来补充搜索。纳入的研究报告了BCVI后卒中的治疗分层风险。所有研究均由两名评审员独立筛选,数据提取一式两份。使用Mantel-Haenszel方法使用随机效应模型对比值比(OR)进行汇总估计进行荟萃分析。
结果:总共3315项研究筛选出39项纳入研究,评估6552例患者(每个研究范围8-920例),共7643例BCVI。卒中发生率为0%至32.8%。在荟萃分析中包括的研究中,总共有405次中风,144(35.5%)在治疗中发生,总中风率为4.5%。Meta分析显示,抗血小板治疗的患者BCVI后卒中发生率较低。抗凝剂(OR0.57;95%CI0.33-0.96,p=0.04);仅评估9项特别比较ASA与肝素的研究,组间卒中发生率相似(OR0.43;95%CI0.15-1.20,p=0.11).11项研究评估了出血并发症,并证明抗血小板的出血风险较低。抗凝剂(OR0.29;95%CI0.13-0.63,p=0.002);5项研究评估了ASA与ASA的出血并发症风险肝素显示ASA的出血并发症发生率较低(OR0.16;95%CI0.04-0.58,p=0.005)。
结论:与使用抗凝药治疗相比,使用抗血小板治疗BCVI患者的卒中和出血并发症的风险较低。使用ASAvs.特别是肝素与卒中风险的差异无关,然而,接受ASA治疗的患者出血并发症较少.根据这些证据,抗血小板应成为BCVI患者的首选治疗策略.
BACKGROUND: Blunt cerebrovascular injury (BCVI) occurs in 1-3% of blunt traumas and is associated with stroke, disability, and mortality if unrecognized and untreated. Early detection and treatment are imperative to reduce the risk of stroke, however, there is significant variation amongst centers and trauma care providers in the specific medical management strategy used. This study compares antiplatelets vs. anticoagulants to determine BCVI-related stroke risk and bleeding complications to better understand the efficacy and safety of various treatment strategies.
METHODS: A systematic
review of MEDLINE, Embase, and Cochrane CENTRAL databases was conducted with the assistance of a medical librarian. The search was supplemented with manual
review of the literature. Included studies reported treatment-stratified risk of stroke following BCVI. All studies were screened independently by two reviewers, and data was extracted in duplicate. Meta-analysis was conducted using pooled estimates of odds ratios (OR) with a random-effects model using Mantel-Haenszel methods.
RESULTS: A total of 3315 studies screened yielded 39 studies for inclusion, evaluating 6552 patients (range 8 - 920 per study) with a total of 7643 BCVI. Stroke rates ranged from 0% to 32.8%. Amongst studies included in the meta-analysis, there were a total of 405 strokes, with 144 (35.5%) occurring on therapy, for a total stroke rate of 4.5 %. Meta-analysis showed that stroke rate after BCVI was lower for patients treated with antiplatelets vs. anticoagulants (OR 0.57; 95% CI 0.33-0.96, p = 0.04); when evaluating only the 9 studies specifically comparing ASA to
heparin, the stroke rate was similar between groups (OR 0.43; 95% CI 0.15-1.20, p = 0.11). Eleven studies evaluated bleeding complications and demonstrated lower risk of bleeding with antiplatelets vs. anticoagulants (OR 0.29; 95% CI 0.13-0.63, p = 0.002); 5 studies evaluating risk of bleeding complications with ASA vs.
heparin showed lower rates of bleeding complications with ASA (OR 0.16; 95% CI 0.04-0.58, p = 0.005).
CONCLUSIONS: Treatment of patients with BCVI with antiplatelets is associated with lower risks of stroke and bleeding complications compared to treatment with anticoagulants. Use of ASA vs.
heparin specifically was not associated with differences in stroke risk, however, patients treated with ASA had fewer bleeding complications. Based on this evidence, antiplatelets should be the preferred treatment strategy for patients with BCVI.