Gaussem P, Martin A-C, Belleville-Rolland T, Helley D, Bachelot-Loza C, Godier A
Service d'hématologie biologique, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; Inserm UMR-S1140, faculté de pharmacie, 75006 Paris, France.
Inserm UMR-S1140, faculté de pharmacie, 75006 Paris, France; Service de cardiologie, service de santé des armées, hôpital d'instruction des Armées-Percy, 92140 Clamart, France.
Transfus Clin Biol. 2017 Sep;24(3):160-165. doi: 10.1016/j.tracli.2017.05.014. Epub 2017 Jun 20.
Antiplatelet agents are at risk for bleeding complications, the management of which differs depending on the clinical situation and on the antiplatelet agent itself. Neutralization of antiplatelets is sometimes necessary, most often leading to platelet transfusion, although the benefit of this strategy is poorly documented. In addition, if platelet transfusion corrects the platelet inhibition induced by aspirin and probably by clopidogrel and prasugrel, it does not neutralize ticagrelor, as a consequence of its pharmacological properties. The clinical benefit of platelet transfusion is limited, and the most recent studies are challenging it. However, it is indicated on a perioperative basis for surgeries with high hemorrhagic risk and is discussed in severe hemorrhages. The neutralization of ticagrelor is a concern and the antidote currently under development may be a solution. In all cases, other therapeutic solutions may be considered, such as administration of desmopressin, tranexamic acid or activated factor VII.
抗血小板药物有发生出血并发症的风险，其处理方法因临床情况和抗血小板药物本身而异。有时需要对抗血小板药物进行中和，最常见的方法是输注血小板，尽管这一策略的益处缺乏充分的文献记载。此外，虽然输注血小板可纠正阿司匹林以及可能由氯吡格雷和普拉格雷诱导的血小板抑制，但由于替格瑞洛的药理特性，它并不能中和替格瑞洛。输注血小板的临床益处有限，最近的研究对其提出了质疑。然而，在围手术期对于出血风险高的手术有应用指征，在严重出血时也会进行讨论。替格瑞洛的中和是一个问题，目前正在研发的解毒剂可能是一种解决方案。在所有情况下，可考虑其他治疗方案，如使用去氨加压素、氨甲环酸或活化凝血因子VII。
