Departments of Emergency Medicine, School of Medicine, University of California, Davis, Sacramento, California 95817-2282, USA.
J Trauma Acute Care Surg. 2012 Jun;72(6):1658-63. doi: 10.1097/TA.0b013e318256dfc5.
Preinjury use of antiplatelet agents (e.g., clopidogrel and aspirin) is a risk factor for increased morbidity and mortality for patients with traumatic intracranial hemorrhage (tICH). Some investigators have recommended platelet transfusion to reverse the antiplatelet effects in tICH. This evidence-based medicine review examines the evidence regarding the impact of platelet transfusion on emergency department (ED) patients with preinjury antiplatelet use and tICH on patient-oriented outcomes.
The MEDLINE, EMBASE, Cochrane Library, and other databases were searched. Studies were selected for inclusion if they compared platelet transfusion with no-platelet transfusion in the treatment of adult ED patients with preinjury antiplatelet use and tICH and reported rates of mortality, neurocognitive function, or adverse effects. We assessed the quality of the included studies using standard criteria.
Five retrospective, registry-based studies were identified, which enrolled 635 patients cumulatively. Based on standard criteria, three studies were of low-quality evidence, and two studies were of very low-quality evidence. One study reported higher in-hospital mortality for patients with platelet transfusion (relative risk, 2.42; 95% confidence interval, 1.2-4.9); another showed a lower mortality rate for patients receiving platelet transfusion (relative risk, 0.21; 95% confidence interval, 0.05-0.95). Three studies did not show any statistical difference in comparing mortality rates between the groups. No studies reported intermediate or long-term neurocognitive outcomes or adverse events.
Five retrospective registry studies with suboptimal methodologies provide inadequate evidence to support the routine use of platelet transfusion in adult ED patients with preinjury antiplatelet use and tICH.
Systematic review, level III.
受伤前使用抗血小板药物（如氯吡格雷和阿司匹林）是创伤性颅内出血（tICH）患者发病率和死亡率增加的一个风险因素。一些研究人员建议输注血小板以逆转 tICH 中的抗血小板作用。本循证医学综述考察了血小板输注对急诊科（ED）受伤前使用抗血小板药物和 tICH 的患者的以患者为导向的结局的影响的证据。
检索了 MEDLINE、EMBASE、Cochrane 图书馆和其他数据库。如果研究比较了血小板输注与不进行血小板输注在治疗受伤前使用抗血小板药物和 tICH 的成年 ED 患者中的效果，并报告死亡率、神经认知功能或不良反应的发生率，则选择这些研究进行纳入。我们使用标准标准评估纳入研究的质量。
确定了 5 项回顾性、基于登记的研究，总共纳入了 635 名患者。根据标准标准，其中 3 项研究的证据质量为低质量，2 项研究的证据质量为极低质量。一项研究报告血小板输注患者的住院死亡率更高（相对风险，2.42；95%置信区间，1.2-4.9）；另一项研究表明接受血小板输注的患者死亡率较低（相对风险，0.21；95%置信区间，0.05-0.95）。有 3 项研究在比较两组死亡率时没有显示出任何统计学差异。没有研究报告中间或长期神经认知结局或不良事件。
五项方法学不尽如人意的回顾性登记研究提供的证据不足以支持常规使用血小板输注治疗受伤前使用抗血小板药物和 tICH 的成年 ED 患者。
系统评价，III 级。
