Arnone Gregory D, Kumar Prateek, Wonais Matt C, Esfahani Darian R, Campbell-Lee Sally A, Charbel Fady T, Amin-Hanjani Sepideh, Alaraj Ali, Seicean Andreea, Mehta Ankit I
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Department of Pathology, University of Illinois at Chicago, Chicago, Illinois, USA.
World Neurosurg. 2018 Mar;111:e895-e904. doi: 10.1016/j.wneu.2018.01.006. Epub 2018 Jan 9.
Platelet transfusions for patients with intracerebral hemorrhage (ICH) on antiplatelet therapy (APT) remain controversial. Diverging past research and differences in platelet preparation warrant further investigation of this topic. In this study, the association between platelet transfusion and clinical outcomes of ICH is investigated in patients matched by ICH score, a validated predictor of mortality.
A consecutive review of all patients from 2012 to 2015 with nontraumatic ICH was performed. Risk factors including demographics, medical comorbidities, APT use, and ICH score were reviewed. Standardized differences were used to assess baseline characteristics; logistic regression models were performed to determine whether platelet transfusions were associated with adverse outcomes, both before and after matching for ICH score.
A total of 538 patients with nontraumatic ICH were investigated. Of these, 168 were on APT; 71 were excluded. Thirty-nine patients (40%) received platelet transfusions and 58 (60%) did not. An overall mortality of 9.3% was measured, with 29.9% of patients enduring complications. In the unmatched cohort, patients who received platelet transfusions were more likely to deteriorate (odds ratio [OR], 4.7), undergo surgical intervention during their hospital stay (OR, 7.2), be discharged with a worse modified Rankin Scale score (OR, 3.6), or die (OR, 6.1). After matching by ICH score, platelet transfusion was not a significant predictor for any negative outcome.
This is the first analysis of platelet transfusions in patients with ICH based on ICH score. For patients on APT, platelet transfusion is not associated with clinical outcomes in an ICH score-matched sample.
对于接受抗血小板治疗（APT）的脑出血（ICH）患者，血小板输注仍存在争议。以往研究结果不一，且血小板制备方法存在差异，因此有必要对这一主题进行进一步研究。在本研究中，我们在根据脑出血评分（一种经过验证的死亡率预测指标）进行匹配的患者中，研究了血小板输注与脑出血临床结局之间的关联。
对2012年至2015年所有非创伤性脑出血患者进行连续回顾性研究。对包括人口统计学、合并症、抗血小板治疗使用情况和脑出血评分在内的危险因素进行了评估。使用标准化差异来评估基线特征；进行逻辑回归模型分析，以确定在根据脑出血评分进行匹配前后，血小板输注是否与不良结局相关。
共调查了538例非创伤性脑出血患者。其中，168例接受抗血小板治疗；71例被排除。39例（40%）患者接受了血小板输注，58例（60%）未接受。总体死亡率为9.3%，29.9%的患者出现并发症。在未匹配的队列中，接受血小板输注的患者病情恶化的可能性更大（优势比[OR]，4.7），住院期间接受手术干预的可能性更大（OR，7.2），出院时改良Rankin量表评分更差（OR，3.6），或死亡的可能性更大（OR，6.1）。根据脑出血评分进行匹配后，血小板输注不是任何负面结局的显著预测因素。
这是首次基于脑出血评分对脑出血患者进行血小板输注分析。对于接受抗血小板治疗的患者，在脑出血评分匹配的样本中，血小板输注与临床结局无关。
