Gremmel T, Panzer S
Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria.
Vox Sang. 2017 Aug;112(6):511-517. doi: 10.1111/vox.12537. Epub 2017 May 30.
Patients on antiplatelet therapy, be it aspirin only, or aspirin in combination with oral adenosine diphosphate (ADP) receptor inhibitors like clopidogrel, prasugrel and ticagrelor, or the protease-activated receptor-1 inhibitor vorapaxar, may develop bleeding or need transient reversal of platelet blockade for acute interventions. In this review, we summarize reports on patients with antiplatelet therapy receiving platelet concentrates due to bleeding, and in vitro experiments estimating the feasibility to restore platelet function by spiking blood from healthy individuals or patients on antiplatelet treatment with noninhibited platelets. So far, all clinical data were gained from patients on aspirin with or without ADP P2Y receptor inhibitors. Platelet inhibition due to clopidogrel, and to some extent also prasugrel may be overcome by platelet transfusion, but clinical data on massive platelet transfusion in these patients are lacking. Platelet transfusion may even be associated with worse outcomes. Ticagrelor-mediated platelet inhibition remains a challenge, as case reports show that platelet transfusion did not restore haemostasis. Prescription of the latter therefore demands a particular stringent indication.
接受抗血小板治疗的患者，无论是仅服用阿司匹林，还是阿司匹林与口服二磷酸腺苷（ADP）受体抑制剂（如氯吡格雷、普拉格雷和替格瑞洛）联合使用，抑或是服用蛋白酶激活受体-1抑制剂沃拉帕沙，都可能出现出血情况，或者在进行急性干预时需要暂时逆转血小板阻滞作用。在本综述中，我们总结了关于因出血而接受血小板浓缩物治疗的抗血小板治疗患者的报告，以及通过向健康个体或接受抗血小板治疗的患者的血液中添加未受抑制的血小板来评估恢复血小板功能可行性的体外实验。到目前为止，所有临床数据均来自服用或未服用ADP P2Y受体抑制剂的阿司匹林患者。氯吡格雷引起的血小板抑制作用，在一定程度上普拉格雷引起的血小板抑制作用，可通过血小板输注来克服，但这些患者大量输注血小板的临床数据尚缺乏。血小板输注甚至可能与更差的预后相关。替格瑞洛介导的血小板抑制作用仍然是一个挑战，因为病例报告显示血小板输注未能恢复止血功能。因此，后者的处方需要特别严格的指征。
