Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
J Clin Neurosci. 2013 Dec;20(12):1805-6. doi: 10.1016/j.jocn.2013.02.022. Epub 2013 Jul 5.
As the population ages, antiplatelet agents are increasingly used in patients with cardiovascular diseases. Due to impaired platelet activity, these patients are at increased risk for bleeding complications and this is of particular importance in patients with intracerebral haemorrhage. The multiple electrode aggregometry analyser Multiplate (Roche Diagnostics, Mannheim, Germany) was introduced in 2006 to monitor the effectiveness of antiplatelet drugs in interventional cardiology. As a point-of-care device, it allows bedside assessment of platelet activity within minutes through analysis of a sample of whole blood. In patients treated with antiplatelet medication and in need of urgent cardiac surgery, these devices allow prediction of intraoperative blood loss and their use was implemented within respective guidelines to direct transfusion strategies. We used the Multiplate analyser for rapid assessment of antiplatelet activity in a patient who developed an intracerebral haemorrhage after administration of aspirin and clopidogrel. Antiplatelet activity was assessed within 10 minutes while the patient was transferred to the operating room and after transfusion of platelet concentrates and administration of desmopressin and tranexamic acid, repeated Multiplate analysis demonstrated nearly normalized platelet activity. In our view, there is great potential for this device to improve treatment in neurosurgery and especially the treatment of antiplatelet-related intracerebral haemorrhage. Instant assessment of antiplatelet activity or effectiveness of haemostatic measures is facilitated and furthermore, patients with normal platelet activity despite a positive history of antiplatelet medication intake can be identified. In these patients, empiric administration of haemostatic substances would unnecessarily increase the risk of thromboembolic events.
随着人口老龄化，抗血小板药物在心血管疾病患者中的应用日益增多。由于血小板活性受损，这些患者出血并发症的风险增加，这在脑出血患者中尤为重要。多电极聚集仪 Multiplate（罗氏诊断公司，德国曼海姆）于 2006 年推出，用于监测介入心脏病学中抗血小板药物的疗效。作为一种即时检测设备，它通过分析全血样本，可在数分钟内对血小板活性进行床边评估。在接受抗血小板药物治疗且需要紧急心脏手术的患者中，这些设备可预测术中失血，并在相应指南的指导下使用，以指导输血策略。我们使用 Multiplate 分析仪快速评估了一名患者的抗血小板活性，该患者在服用阿司匹林和氯吡格雷后发生脑出血。在将患者转至手术室的同时进行了抗血小板活性评估，输注血小板浓缩物和给予去氨加压素及氨甲环酸后，重复进行 Multiplate 分析，结果显示血小板活性几乎恢复正常。我们认为，这种设备在神经外科治疗中具有很大的潜力，尤其是在治疗抗血小板相关的脑出血方面。即时评估抗血小板活性或止血措施的效果变得更加容易，此外，还可以识别出尽管有抗血小板药物摄入的阳性病史但血小板活性正常的患者。在这些患者中，经验性给予止血物质会不必要地增加血栓栓塞事件的风险。
