From the Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, The University of Arizona, Tucson, Arizona.
J Trauma Acute Care Surg. 2013 Dec;75(6):990-4. doi: 10.1097/TA.0b013e3182a96591.
Platelet transfusion is increasingly used in patients with traumatic intracranial hemorrhage (ICH) on aspirin therapy to minimize the progression of ICH. We hypothesized (null) that platelet transfusion in this cohort of patients does not improve platelet function.
We performed a prospective interventional trail on patients with traumatic ICH on daily high-dose (325 mg) aspirin therapy. All patients received one pack of apheresis platelets. Blood samples were collected before and 1 hour after platelet transfusion. Platelet function was assessed using Verify Now Platelet Function Assay, and a cutoff of greater than 550 aspirin reaction units was used to define functioning platelets (FP).
Twenty-eight patients were enrolled in the study. On presentation, 79% (22 of 28) of the patients had nonfunctioning platelets (NFPs), and transfusion of platelets did not improve platelet function as 81% (18 of 22) still had NFP. Of the 22 patients, 4 converted from NFP to FP after transfusion. There was no difference in the progression of ICH (37.5% vs. 30%, p = 0.7) or neurosurgical intervention (12.5% vs. 15%, p = 0.86) between patients with FP and NFP after platelet transfusion.
Administration of one pack of apheresis platelet did not improve platelet function. In our study, progression of ICH and the need for neurosurgical intervention were independent of platelet function. Further randomized clinical trials are required to assess both the dose dependence effect and role of platelet transfusion in patients on antiplatelet therapy with traumatic ICH.
Therapeutic study, level III.
在接受阿司匹林治疗的创伤性颅内出血（ICH）患者中，越来越多地使用血小板输注来减少 ICH 的进展。我们假设（零假设），在这组患者中，血小板输注并不能改善血小板功能。
我们对接受大剂量（325 毫克）阿司匹林每日治疗的创伤性 ICH 患者进行了前瞻性干预试验。所有患者均输注了 1 袋单采血小板。在血小板输注前和输注后 1 小时采集血液样本。使用 VerifyNow 血小板功能测定法评估血小板功能，并使用大于 550 阿司匹林反应单位的截定点来定义有功能的血小板（FP）。
本研究共纳入 28 例患者。就诊时，79%（22/28）的患者存在无功能血小板（NFPs），输注血小板并不能改善血小板功能，因为仍有 81%（18/22）的患者存在 NFPs。在这 22 名患者中，有 4 名患者的 NFPs 在输注后转化为 FP。血小板输注后，FP 患者与 NFP 患者的 ICH 进展（37.5%比 30%，p=0.7）或神经外科干预（12.5%比 15%，p=0.86）无差异。
输注 1 袋单采血小板并未改善血小板功能。在我们的研究中，ICH 的进展和神经外科干预的需要与血小板功能无关。需要进一步的随机临床试验来评估抗血小板治疗合并创伤性 ICH 患者血小板输注的剂量依赖性效应和作用。
治疗性研究，III 级。
