Clinical features and outcomes of intracerebral hemorrhage induced by coagulation dysfunction: analysis of 134 cases

Liang TAN; Ju WANG; Jishu XIAN; Zhouyang JIANG; Hongping MIAO; Chao ZHANG; Rong HU; Hua FENG

doi:10.16016/j.1000-5404.201810187

您当前的位置：

首页 >

文章列表页 >

Clinical features and outcomes of intracerebral hemorrhage induced by coagulation dysfunction: analysis of 134 cases

Clinical Medicine | 更新时间：2026-01-09

- Clinical features and outcomes of intracerebral hemorrhage induced by coagulation dysfunction: analysis of 134 cases
- Journal of Third Military Medical University Vol. 41, Issue 7, Pages: 701-705(2019)
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院神经外科
- 作者简介：
- 基金信息：
  
  the National Natural Science Foundation for Young Scholars of China(81601026);the Military Medical Science and Technology Innovation Plan of First Affiliated Hospital of Army Medical University(SWH2016JSYB-06)
- DOI：10.16016/j.1000-5404.201810187
  CLC： R181.32;R554;R743.34
- Received：30 October 2018，
  
  Revised：2018-12-16，
  
  Published：15 April 2019
- 稿件说明：
移动端阅览
Liang TAN, Ju WANG, Jishu XIAN, et al. Clinical features and outcomes of intracerebral hemorrhage induced by coagulation dysfunction: analysis of 134 cases[J]. Journal of Third Military Medical University, 2019, 41(7): 701-705.
DOI：

Liang TAN, Ju WANG, Jishu XIAN, et al. Clinical features and outcomes of intracerebral hemorrhage induced by coagulation dysfunction: analysis of 134 cases[J]. Journal of Third Military Medical University, 2019, 41(7): 701-705. DOI： 10.16016/j.1000-5404.201810187.

摘要

目的

分析凝血功能障碍所导致脑出血的临床特点，探讨有效的治疗方法。

方法

收集2000年1月至2016年8月本科收治的凝血功能障碍所致脑出血患者134例，分析其凝血障碍类型、治疗方式、病死率、出院时改良兰金量表评分(modified rankin scale，mRS)、围手术期并发症(血肿扩大、肺部感染、脑积水、上消化道出血、深静脉血栓等)。

结果

出院时按mRS评分评估患者的预后，病死(mRS：6分)54例，严重残疾(mRS：3~5分)47例，预后良好(mRS：1~2分)33例；其中华法林和血液病所致脑出血的预后最差，病死率达50%以上。对于出血量为

30~80 mL的脑出血患者，32例(47%)采取保守治疗，其中23例患者死亡，病死率为71.9%；36例(53%)采取手术治疗，其中16例患者死亡，病死率为44.4%。手术组病死率显著低于保守治疗组(

0.05)。手术组病例住院时间为(17.02±5.90)d，显著短于保守治疗组病例住院时间[(20.09±5.35)d，

0.05

]

。

结论

凝血功能障碍所致脑出血患者预后较差，应严密监测各项凝血功能，并在早期迅速纠正凝血功能，预防并发症；早期手术治疗对于血肿较大的凝血功能障碍性脑出血患者预后有改善作用。

Abstract

Objective

To analyze the clinical characteristics and outcomes of intracerebral hemorrhage induced by coagulation dysfunction and explore its optimal interventions.

Methods

From January 2000 to August 2016

a total of 134 patients with cerebral hemorrhage caused by coagulation dysfunction were admitted in our department. The types of coagulation disorders

interventions

mortality

modified Rankin Scale (mRS) scores at discharge

and perioperative complications (hematoma enlargement

pulmonary infection

hydrocephalus

alimentary tract hemorrhage

and deep venous thrombosis) were analyzed in these patients.

Results

The prognosis of the patients was evaluated based on mRS scores at discharge. Among the 134 patients

54 died (mRS score of 6)

47 had severe disabilities (mRS scores of 3~5)

and 33 had favorable prognoses (mRS scores of 1~2). The patients with intracerebral hemorrhage associated with the use of warfalin and hematologic disease had the worst prognosis with a mortality rate above 50%. In the patients with a hemorrhage volume of

30~80 mL

32 received conservative treatment and 36 underwent surgical interventions

and the mortality r

ate was significantly higher in the patients with conservative treatment than those undergoing surgical treatment (71.9%

44.4%

0.05); the average length of hospital stay was also significantly longer in the conservative treatment group than in the surgical group (20.09±5.35

17.02±5.90 d

0.05).

Conclusion

The patients with intracerebral hemorrhage caused by coagulation dysfunction have poorer outcomes than those with hypertensive intracerebral hemorrhage. Early and effective interventions of coagulation dysfunction

close monitoring of potential complications and early surgical intervention can improve the outcomes of patients with large intracerebral hematoma.

关键词

Keywords

references

KAWANO-CASTILLO J, WARD E, ELLIOTT A, et al. Thrombelastography detects possible coagulation disturbance in patients with intracerebral hemorrhage with hematoma enlargement[J]. Stroke, 2014, 45(3): 683-688. DOI: 10.1161/STROKEAHA.113.003826.

MA M M, MERETOJA A, CHURILOV L, et al. Warfarin-associated intracerebral hemorrhage: volume, anticoagulation intensity and location[J]. J Neurol Sci, 2013, 332(1/2): 75-79. DOI: 10.1016/j.jns.2013.06.020.

ROSAND J, ECKMAN M H, KNUDSEN K A, et al. The effect of warfarin and intensity of anticoagulation on outcome of intracerebral hemorrhage[J]. Arch Intern Med, 2004, 164(8): 880-884. DOI: 10.1001/archinte.164.8.880.

SJ BLOM L, H RDEMARK H G, LINDGREN A, et al. Management and prognostic features of intracerebral hemorrhage during anticoagulant therapy: a Swedish multicenter study[J]. Stroke, 2001, 32(11): 2567-2574.

MAYER S A, BRUN N C, BEGTRUP K, et al. Efficacy and safety of recombinant activated factor Ⅶ for acute intracerebral hemorrhage[J]. N Engl J Med, 2008, 358(20): 2127-2137. DOI: 10.1056/NEJMoa0707534.

FLIBOTTE J J, HAGAN N, O'DONNELL J, et al. Warfarin, hematoma expansion, and outcome of intracerebral hemorrhage[J]. Neurology, 2004, 63(6): 1059-1064.

鲁大双, 王启华, 崔杰, 等.凝血功能障碍性脑出血的治疗[J].海南医学院学报, 2012, 18(1): 74-76. DOI: 46-1049/R.20111202.1034.007.

LU D S, WANG Q H, CUI J, et al. Treatment for cerebral hemorrhage due to coagulation disorders[J]. J Hainan Med Univ, 2012, 18(1): 74-76. DOI: 46-1049/R.20111202.1034.007.

ROMERO N, LUPI K, CARTER D, et al. The role of double and triple therapy with direct oral anticoagulants in coronary artery disease, peripheral artery disease, and stroke[J]. Clin Ther, 2018, 40(11): 1907-1917.e3. DOI:10.1016/j.clinthera.2018.09.014.

YASAKA M. New insights into nonvitamin K antagonist oral anticoagulants' reversal of intracerebral hemorrhage[J]. Front Neurol Neurosci, 2015, 37: 93-106. DOI: 10.1159/000437116.

GREENBLATT D J, VON MOLTKE L L. Interaction of warfarin with drugs, natural substances, and foods[J]. J Clin Pharmacol, 2005, 45(2): 127-132. DOI: 10.1177/0091270004271404.

KURAMATSU J B, GERNER S T, SCHELLINGER P D, et al. Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage[J]. JAMA, 2015, 313(8): 824-836. DOI: 10.1001/jama.2015.0846.

TAKARADA K, SATO M, GOTO M, et al. Long-term PT-INR levels and the clinical events in the patients with non-valvular atrial fibrillation: a special reference to low-intensity warfarin therapy[J]. J Cardiol, 2014, 64(2): 127-132. DOI: 10.1016/j.jjcc.2013.11.015.

YU Y, WU J, ZHAO W, et al. Calibrated automated thrombography for monitoring coagulation function in patients with intracerebral haemorrhage[J]. J Int Med Res, 2015, 43(3): 316-325. DOI: 10.1177/0300060514565801.

BURCHELL S R, TANG J P, ZHANG J H. Hematoma expansion following intracerebral hemorrhage: mechanisms targeting the coagulation cascade and platelet activation[J]. Curr Drug Targets, 2017, 18(12): 1329-1344. DOI: 10.2174/1389450118666170329152305.

CORDONNIER C, DEMCHUK A, ZIAI W, et al. Intracerebral haemorrhage: current approaches to acute management[J]. Lancet, 2018, 392(10154): 1257-1268. DOI: 10.1016/s0140-6736(18)31878-6.

BRAILOIU E, BARLOW C L, RAMIREZ S H, et al. Effects of platelet-activating factor on brain microvascular endothelial cells[J]. Neuroscience, 2018, 377: 105-113. DOI: 10.1016/j.neuroscience.2018.02.039.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Effects and underlying mechanisms of novel phenothiazine derivative DA414 in rats with intracerebral hemorrhage

Autophagy inducer spermidine improves brain injury after intracerebral hemorrhage

Notch1 regulates hippocampal neurogenesis and recovery of neurological function in mice after intracerebral hemorrhage

Application of neuroendoscopy in transcranial treatment of ventricle-related deep-seated tumors

NDP-MSH activates melanocortin-3 receptor to attenuate oxidative stress and neuronal apoptosis in mice with intracerebral hemorrhage via PKC/ERK signaling pathway

Related Author

MA Yufan

WANG Bingqiao

LIN Sen

YANG Qingwu

QI Lingxiao

YAN Gaili

XUE Mengzhou

Jing CHEN

Related Institution

Department of Neurology， Second Affiliated Hospital， Army Medical University （Third Military Medical University）

Department of Cerebrovascular Diseases， Second Affiliated Hospital of Zhengzhou University, Zhengzhou University

Academy of Medical Sciences, Zhengzhou University

Department of Neurology, Baoji Gaoxin People's Hospital

Department of Neurology, Xinqiao Hospital, Third Military Medical University

⁰