Washington Chad W, Schuerer Douglas J E, Grubb Robert L
Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
J Trauma. 2011 Aug;71(2):358-63. doi: 10.1097/TA.0b013e318220ad7e.
To determine whether there is a benefit to platelet transfusion in mild traumatic brain injury (MTBI) patients with intracranial hemorrhage (ICH), taking antiplatelet therapy before hospitalization.
The study design retrospectively reviewed patients admitted to a Level I trauma center during a 2-year period with an isolated MTBI (Glasgow Coma Scale score ≥13, ICH seen on a head computed tomographic scan (head computed tomography [HCT]), and taking an antiplatelet agent before hospitalization. HCT's were categorized based on the Marshall Classification, Rotterdam Score, and ICH volume. Hospital records were reviewed noting neurologic, cardiac, respiratory events, and discharge Glasgow Outcome Scale.
There were 1,101 patients with TBI hospitalized during the 2-year study period. Three hundred twenty-one of these patients had an MTBI with ICH at the time of admission, and from this group, 113 were taking an antiplatelet agent. Only 4 (1.2%) of the 321 patients suffered a neurologic decline. All were gradual in nature, and none required emergent intervention. An analysis of the 113 patients taking antiplatelet agents, comparing patients who were not given a platelet transfusion with those who received a platelet transfusion, found no significant difference in the rate of HCT progression, neurologic decline, or Glasgow Outcome Scale at hospital discharge between the two groups. There was a trend, which was not significant, toward more medical declines in patients who received a platelet transfusion. A further review, analyzing all 321 patients with ICH showed receiving a transfusion of any type (i.e., platelets, fresh frozen plasma, or blood) was a strong predictor of medical decline (p < 0.0001). The odds ratio of having a medical decline after transfusion was 5.8 (95% confidence interval, 1.2-28.2).
Platelet transfusion did not improve short-term outcomes after MTBI. Further randomized controlled trials need to be done to truly assess if there is no benefit in platelet transfusion in patients taking antiplatelet agents suffering an MTBI. Because the overall outcome in MTBI patients is favorable, platelet transfusion in these patients may not be indicated.
为了确定对于在住院前接受抗血小板治疗、患有颅内出血（ICH）的轻度创伤性脑损伤（MTBI）患者，血小板输注是否有益。
本研究设计回顾性分析了在两年期间入住一级创伤中心的患者，这些患者患有单纯性MTBI（格拉斯哥昏迷量表评分≥13，头部计算机断层扫描（头部CT）显示有ICH），且在住院前接受抗血小板药物治疗。根据马歇尔分类法、鹿特丹评分和ICH体积对头部CT进行分类。查阅医院记录，记录神经、心脏、呼吸事件以及出院时的格拉斯哥预后量表评分。
在为期两年的研究期间，有1101例创伤性脑损伤患者住院。其中321例患者入院时患有MTBI并伴有ICH，在这组患者中，113例正在接受抗血小板药物治疗。321例患者中只有4例（1.2%）出现神经功能衰退。所有衰退均为渐进性，且无一例需要紧急干预。对113例接受抗血小板药物治疗的患者进行分析，比较未接受血小板输注的患者和接受血小板输注的患者，发现两组之间在头部CT进展率、神经功能衰退或出院时的格拉斯哥预后量表评分方面没有显著差异。接受血小板输注的患者出现更多医疗衰退有一个趋势，但不显著。进一步回顾分析所有321例ICH患者显示，接受任何类型的输血（即血小板、新鲜冰冻血浆或血液）是医疗衰退的一个强有力预测因素（p < 0.0001）。输血后出现医疗衰退的比值比为5.8（95%置信区间，1.2 - 28.2）。
血小板输注并未改善MTBI后的短期预后。需要进行进一步的随机对照试验，以真正评估对于接受抗血小板药物治疗且患有MTBI的患者，血小板输注是否没有益处。由于MTBI患者的总体预后良好，这些患者可能不需要进行血小板输注。
