Batchelor John S, Grayson Alan
Department of Emergency Medicine, Manchester Royal Infirmary, Manchester, UK.
BMJ Open. 2012 Apr 5;2(2):e000588. doi: 10.1136/bmjopen-2011-000588. Print 2012.
The aim of this study was to evaluate by meta-analysis the current level of evidence in order to establish the impact of a platelet transfusion on survival in patients on pre-injury antiplatelet agents who sustain an intracranial haemorrhage (either spontaneous or traumatic).
This was a meta-analysis; the MEDLINE Database was searched using the PubMed interface and the Ovid interface. CINAHL and EMBASE Databases were also searched. The search was performed to identify randomised controlled trials (RCT)'s case-controlled studies or nested case-controlled studies. Comparing the outcome (death or survival) of patients with intracranial haemorrhage (ICH) and pre-injury antiplatelet agents who received a platelet transfusion against a similar cohort of patients who did not receive a platelet transfusion.
499 citations were obtained from the PubMed search. 31 full articles were reviewed from 34 abstracts. 6 studies were found suitable for the meta-analysis. No randomised controlled studies were identified. 2 of the six studies were in patients with spontaneous ICH. The remaining four studies were in patients with traumatic intracranial haemorrhage. Significant heterogeneity was present between the studies, I(2)=58.276. The random effects model was therefore the preferred model, this produced a pooled OR for survival of 0.773 (95% CI 0.414 to 1.442).
The results of this meta-analysis has shown, based upon six small studies, that there was no clear benefit in terms of survival in the administration of a platelet transfusion to patients with antiplatelet-associated ICH. Further work is required in order to establish any potential benefit in the administration of a platelet transfusion in patients with spontaneous or traumatic intracranial haemorrhage who were on pre-injury antiplatelet agents.
本研究旨在通过荟萃分析评估现有证据水平，以确定血小板输注对颅内出血（自发性或外伤性）且受伤前使用抗血小板药物患者生存的影响。
这是一项荟萃分析；使用PubMed界面和Ovid界面检索MEDLINE数据库。还检索了CINAHL和EMBASE数据库。检索旨在识别随机对照试验（RCT）、病例对照研究或巢式病例对照研究。比较颅内出血（ICH）且受伤前使用抗血小板药物并接受血小板输注的患者与未接受血小板输注的类似患者队列的结局（死亡或生存）。
通过PubMed检索获得499条引用。从34篇摘要中审查了31篇全文。发现6项研究适合进行荟萃分析。未识别到随机对照研究。6项研究中有2项针对自发性ICH患者。其余4项研究针对外伤性颅内出血患者。研究之间存在显著异质性，I(2)=58.276。因此，随机效应模型是首选模型，该模型得出的生存合并比值比为0.773（95%置信区间0.414至1.442）。
基于6项小型研究的这项荟萃分析结果表明，对于抗血小板相关ICH患者，输注血小板在生存方面没有明显益处。对于受伤前使用抗血小板药物的自发性或外伤性颅内出血患者，需要进一步研究以确定输注血小板的任何潜在益处。
