Cerebral Atrophy, Anticoagulants, and the Risk for Chronic Subdural Hematoma

脑萎缩、抗凝剂和慢性硬膜下血肿的风险

• 批准号: 8541979
• 负责人: Uzma Samadani
• 金额: --
• 依托单位: VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-01-01 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8541979
• 关键词: Accounting; Adult; Affect; Age; Alcoholism; American; American Heart Association; Anticoagulant therapy; Anticoagulants; Antiplatelet Drugs; Aspirin; Atrophic; Blood Vessels; Blood coagulation; Brain; Brain Diseases; Brain Neoplasms; Brain imaging; Caregivers; Cephalic; Chronic; Clinical; Communities; Consumption; Dementia; Development; Disabled Persons; Disease; Dura Mater; Elderly; Etiology; Event; Goals; Grant; Head; Hematoma, Subdural, Chronic; Hemorrhage; Hospitals; Hydrocephalus; Hypoxia; Image; Incidence; Individual; Intracranial Hemorrhages; Ischemic Stroke; Lead; Life Expectancy; Location; Longevity; Medical; Medical Records; Methods; Myocardial Infarction; Neurodegenerative Disorders; Operative Surgical Procedures; Outcome; Patients; Pattern; Persons; Pharmaceutical Preparations; Population; Populations at Risk; Predisposition; Prevention; Recommendation; Recording of previous events; Recurrence; Relative Risks; Research; Risk; Risk Factors; Scanning; Seizures; Sleep Apnea Syndromes; Software Tools; Stretching; Subdural Hematoma; Surface; Surveys; System; Testing; Time; Transient Ischemic Attack; Trauma; Traumatic Brain Injury; Unstable angina; Veins; Veterans; Work; X-Ray Computed Tomography; cerebral atrophy; cigarette smoking; clinical application; cohort; follow-up; high risk; novel; patient population; prevent; public health relevance; screening; success; tool

DESCRIPTION (provided by applicant): As the American population ages, bleeding on the surface of the brain (subdural hematoma) has become increasingly common. By 2030 subdural hematoma will be a more frequent surgical problem than both primary and metastatic brain tumors. In the 1960's only 1or 2 of 100,000 people was affected by subdural hematoma each year, but by 2005, that number grew to 20 of 100,000 people per year. In our patient population of adult veterans from 2005-2010, the incidence was 31.5 per 100,000 per year. People requiring surgery for subdural hematomas are often in the hospital for longer time than patients with brain tumors. Subdural hematoma patients may be disabled by their disease, and have a shortened life expectancy. It is possible that the increase in incidence of subdural hematoma is due to increased consumption of aspirin and other blood thinning medications. Older people and other populations at risk for brain atrophy (shrinkage) may be most at risk for subdural hematoma because veins on the surface of the brain are stretched and torn more easily in these patients. In this grant, we propose to demonstrate that the amount and pattern of brain atrophy impacts the risk of chronic subdural hematoma, and that consuming aspirin or blood thinners further compounds that risk. The purpose of this work is to establish that a screening tool that evaluates brain images and quantitates atrophy is useful for assessing risk prior to starting aspirin or blood thinners in people who are most at risk for such bleeding. We will study a cohort of 10,351 veterans who all had imaging studies of their brains performed during the years 2005-10 with a novel automated method for quantitating atrophy using standard CT scans of the head. We will also record whether or not these individuals consumed aspirin or blood thinners. We will follow the patients for four years and track whether they develop subdural hematomas, or other disorders related to brain bleeding or blood clotting. We will then perform statistical analyses to determine how much the risks of atrophy and consumption of aspirin and blood thinners separately and together impact the risk for development of subdural hematoma. The success of this project would enable prevention of an increasingly common, disabling and potentially fatal brain disorder that already impacts the lives of 60,000 Americans per year.

描述（由申请人提供）： 随着美国人口老龄化，大脑表面出血（硬膜下血肿）变得越来越常见。到 2030 年，硬膜下血肿将成为比原发性和转移性脑肿瘤更常见的手术问题。在 1960 年代，每年只有 10 万人中只有 1 或 2 人受到硬膜下血肿的影响，但到了 2005 年，这一数字增长到每年 10 万人中的 20 人。在 2005 年至 2010 年的成年退伍军人患者群体中，每年发病率为每 10 万人中 31.5 例。需要手术治疗硬膜下血肿的患者通常比脑肿瘤患者住院时间更长。硬膜下血肿患者可能会因疾病而致残，并缩短预期寿命。 硬膜下血肿发病率的增加可能是由于阿司匹林和其他血液稀释药物的消耗增加所致。老年人和其他有脑萎缩风险的人群可能最容易发生硬膜下血肿，因为这些患者大脑表面的静脉更容易拉伸和撕裂。 在这笔资助中，我们建议证明脑萎缩的数量和模式会影响慢性硬膜下血肿的风险，而服用阿司匹林或血液稀释剂会进一步加剧这种风险。这项工作的目的是建立一种评估大脑图像和定量萎缩的筛查工具，可用于在最有出血风险的人群开始服用阿司匹林或血液稀释剂之前评估风险。 我们将研究 10,351 名退伍军人，他们都在 2005-10 年期间使用一种新颖的自动化方法对他们的大脑进行了成像研究，使用标准头部 CT 扫描来量化萎缩情况。我们还将记录这些人是否服用阿司匹林或血液稀释剂。我们将跟踪患者四年，追踪他们是否出现硬膜下血肿或其他与脑出血或凝血相关的疾病。然后我们将进行统计分析以确定 萎缩的风险以及单独和共同服用阿司匹林和血液稀释剂对硬膜下血肿发生风险的影响有多大。 该项目的成功将能够预防一种日益常见、致残且可能致命的脑部疾病，这种疾病每年已经影响 60,000 美国人的生活。