Beynon Christopher, Scherer Moritz, Jakobs Martin, Jung Carla, Sakowitz Oliver W, Unterberg Andreas W
Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
Clin Neurol Neurosurg. 2013 Oct;115(10):2003-8. doi: 10.1016/j.clineuro.2013.06.002. Epub 2013 Jul 2.
As the population ages, physicians encounter a growing number of patients who are treated with antiplatelet agents and present with severe conditions requiring urgent neurosurgical therapy. Standard laboratory investigations are insufficient to evaluate platelet activity and furthermore, it is difficult to evaluate effects of haemostatic measures on platelet function. In this article we report our initial experiences with the point-of-care device Multiplate® for assessment of platelet activity in neurosurgical emergencies on patients with a reported intake of antiplatelet medication.
Multiplate® assessment of antiplatelet activity was carried out in 21 non-consecutive patients with a reported intake of antiplatelet medication (aspirin: n=21, clopidogrel: n=3, ticragrelor: n=1) and urgent admission to our hospital because of conditions such as intracranial haemorrhage requiring urgent neurosurgical therapy. Analysis was repeated in order to evaluate the effectiveness of haemostatic drugs and platelet concentrate transfusion on platelet activity in six patients.
No technical difficulties occurred and in all cases, results were obtained within 15 min. On admission, patients' arachidonic acid induced platelet activity was reduced by 44.4±33.5% (range: -79.7% to +44.3%) compared to the lower reference limit. Two patients had a normal platelet activity despite a reported intake of aspirin. Haemostatic measures significantly increased arachidonic acid induced platelet activity by 100±66% (p<0.005).
The Multiplate® device allowed rapid assessment of antiplatelet agent activity and evaluation of haemostatic measures on platelet activity. Further studies with larger patient numbers are needed, but this device may represent a valuable tool to improve treatment modalities in patients treated with antiplatelet medication and conditions requiring urgent neurosurgical therapy.
随着人口老龄化，医生遇到越来越多接受抗血小板药物治疗且患有需要紧急神经外科治疗的严重疾病的患者。标准实验室检查不足以评估血小板活性，此外，难以评估止血措施对血小板功能的影响。在本文中，我们报告了我们使用即时检测设备Multiplate®评估服用抗血小板药物的患者在神经外科急诊中的血小板活性的初步经验。
对21例非连续报告服用抗血小板药物的患者（阿司匹林：n = 21，氯吡格雷：n = 3，替格瑞洛：n = 1）进行Multiplate®抗血小板活性评估，这些患者因颅内出血等情况需要紧急神经外科治疗而紧急入院。对6例患者重复进行分析，以评估止血药物和血小板浓缩物输注对血小板活性的有效性。
未出现技术困难，所有病例均在15分钟内获得结果。入院时，与较低参考限值相比，患者花生四烯酸诱导的血小板活性降低了44.4±33.5%（范围：-79.7%至+44.3%）。两名患者尽管报告服用了阿司匹林，但血小板活性正常。止血措施使花生四烯酸诱导的血小板活性显著增加了100±66%（p<0.005）。
Multiplate®设备能够快速评估抗血小板药物活性，并评估止血措施对血小板活性的影响。需要对更多患者进行进一步研究，但该设备可能是改善接受抗血小板药物治疗且患有需要紧急神经外科治疗疾病的患者治疗方式的有价值工具。
