Department of Neurology, Northwestern University's Feinberg School of Medicine, Chicago, IL 60611, USA.
Neurocrit Care. 2012 Feb;16(1):82-7. doi: 10.1007/s12028-011-9619-3.
In patients with acute intracerebral hemorrhage (ICH), reduced platelet activity on admission predicts hemorrhage growth and poor outcomes. We tested the hypotheses that platelet transfusion improves measured platelet activity. Further, we hypothesized that earlier treatment in patients at high risk for hemorrhage growth and poor outcome would reduce follow-up hemorrhage size and poor clinical outcomes.
We prospectively identified consecutive patients with ICH who had reduced platelet activity on admission and received a platelet transfusion. We defined high-risk patients as per a previous publication, reduced platelet activity, or known anti-platelet therapy (APT) and the diagnostic CT within 12 h of symptom onset. Platelet activity was measured with the VerifyNow-ASA (Accumetrics, CA), ICH volumes on CT with computerized quantitative techniques, and functional outcomes with the modified Rankin Scale (mRS) at 3 months.
Forty-five patients received a platelet transfusion with an increase in platelet activity from 472 ± 50 (consistent with an aspirin effect) to 561 ± 92 aspirin reaction units (consistent with no aspirin effect, P < 0.001). For high-risk patients, platelet transfusion within 12 h of symptom onset, as opposed to >12 h, was associated with smaller follow-up hemorrhage size (8.4 [3-17.4] vs. 13.8 [12.3-62.5] ml, P = 0.04) and increased odds of independence (mRS < 4) at 3 months (11 of 20 vs. 0 of 7, P = 0.01). There were similar results for patients with known APT.
In patients at high risk for hemorrhage growth and poor outcome, early platelet transfusion improved platelet activity assay results and was associated with smaller final hemorrhage size and more independence at 3 months.
在急性脑出血（ICH）患者中，入院时血小板活性降低预示着出血扩大和不良结局。我们检验了以下假设：血小板输注可改善血小板活性的测量值。此外，我们假设对高出血风险和不良预后患者进行早期治疗可减少随访期间的出血体积和不良临床结局。
我们前瞻性地识别了入院时血小板活性降低且接受血小板输注的连续ICH 患者。我们将高危患者定义为先前发表的研究中的患者、血小板活性降低或已知抗血小板治疗（APT）和症状发作后 12 小时内的诊断 CT。通过 Accumetrics 的 VerifyNow-ASA（Accumetrics，CA）测量血小板活性，使用计算机定量技术测量 CT 上的 ICH 体积，并在 3 个月时使用改良 Rankin 量表（mRS）评估功能结局。
45 例患者接受了血小板输注，血小板活性从 472±50（与阿司匹林效应一致）增加到 561±92 阿司匹林反应单位（与无阿司匹林效应一致，P＜0.001）。对于高危患者，症状发作后 12 小时内而不是＞12 小时内进行血小板输注与较小的随访出血体积相关（8.4[3-17.4] vs. 13.8[12.3-62.5]ml，P=0.04），并且在 3 个月时独立的可能性更高（mRS＜4）（20 例中有 11 例 vs. 7 例中无 0 例，P=0.01）。已知有 APT 的患者也有类似的结果。
在有出血扩大和不良结局高风险的患者中，早期血小板输注改善了血小板活性测定结果，并与较小的最终出血体积和 3 个月时更高的独立性相关。
