院前使用抗凝剂对颅脑损伤后预防VTE的影响

目前，抗凝治疗（包括抗血小板药物）在常见心血管疾病救治中的应用越来越广泛，然而这种抗凝治疗给颅脑损伤（TBI）后的患者在预防静脉血栓栓塞症（VTE）方面带来了困难和挑战。且TBI后VTE预防性抗凝治疗的药物选择与TBI的治疗效果明显相关。目前对院前正在抗凝治疗的TBI患者在预防VTE方面抗凝剂的选择、抗凝剂过量的对抗以及检测方法等方面仍没有成熟统一的观点。院前抗凝剂的使用对TBI后抗凝治疗的影响有两个方面：一方面院前抗凝剂使用带来的出血等副作用，另一方面TBI能进一步增加改变凝血障碍的可能性。本综述除了总结院前常用的抗凝剂的药物特点，也介绍了与之相关的各种检测手段的优缺点，目的是对院前已经使用过抗凝治疗的TBI患者在预防VTE方面提供全面的参考和指导。

Intervention of prehospital anticoagulation therapy on prophylaxis of venous thromboembolism following traumatic brain injury

Anticoagulation therapy including antiplatelet choice before hospital is increasing in common cardiovascular diseases. However, prehospital anticoagulation is presenting more complex and challenge for the neurosurgeon on prophylactic venous thromboembolism (VTE) of traumatic brain injury (TBI) patients. But the pharmacologic options of anticoagulation for VTE prophylaxis following TBI are related to the consequence of TBI treatment. Unfortunately we presently have not consistent viewpoint under this situation for selection of anticoagulants, over-dose reversal and monitoring of anticoagulation. Prehospital use of anticoagulants affect the VTE prophylaxis on two aspects: one is the side effects of anticoagulants, the other is that coagulation disorder may be produced following TBI. This review summarizes the advantages and drawbacks of various monitoring methods for frequent used coagulants before hospital in addition to their therapeutic characters, the goal is to supply a recommendation and guideline of VTE prophylaxis for TBI patients following prehospital anticoagulation therapy.