Pandya Urmil, Malik Alexander, Messina Michael, Albeiruti Abdul-Rahman, Spalding Chance
Trauma Services, Grant Medical Center, 111 South Grant Avenue, Columbus, OH United States.
Northeast Ohio Medical University, Rootstown, OH United States.
J Clin Neurosci. 2018 Apr;50:88-92. doi: 10.1016/j.jocn.2018.01.073. Epub 2018 Feb 13.
Reversal of antiplatelet therapy with platelet transfusion in traumatic intracranial hemorrhage remains controversial. Several studies have examined this topic but few have investigated whether the timing of transfusion affects outcomes. Patients admitted to a level 1 trauma center from 1/1/14 to 3/31/16 with traumatic intracranial hemorrhage taking pre-injury antiplatelet therapy were retrospectively analyzed. Patients on concurrent pre-injury anticoagulant therapy were excluded. Per institutional guideline, patients on pre-injury clopidogrel received 2 doses of platelets while patients on pre-injury aspirin received 1 dose of platelets. Patients with worsening hemorrhage defined by an increase in the Rotterdam score on follow up CT were compared to those without worsening. Mortality, need for neurosurgical intervention, and timing of platelet transfusion were analyzed. A total of 243 patients were included with 23 (9.5%) having worsening hemorrhage. Patients with worsening hematoma had higher injury severity score, head abbreviated injury scale, incidence of subdural hematoma, mortality, and lower Glasgow coma scale. There was no significant difference in the number of minutes to platelet transfusion between groups. After logistic regression analysis the presence of subdural hematoma and lower admission Glasgow coma scale were predictors of worsening hematoma, while there remained no significant difference in minutes to platelet transfusion. The timing of platelet transfusion did not have any impact on rates of worsening hematoma for patients with traumatic intracranial hemorrhage on pre-injury antiplatelet therapy. Potential risk factors for worsening hematoma in this group are the presence of subdural hematoma and lower admission Glasgow coma scale.
在创伤性颅内出血中，通过输注血小板来逆转抗血小板治疗仍存在争议。多项研究探讨了这一话题，但很少有研究调查输血时机是否会影响治疗结果。对2014年1月1日至2016年3月31日期间因创伤性颅内出血而接受伤前抗血小板治疗并入住一级创伤中心的患者进行了回顾性分析。排除伤前同时接受抗凝治疗的患者。根据机构指南，伤前服用氯吡格雷的患者接受2剂血小板，而伤前服用阿司匹林的患者接受1剂血小板。将随访CT显示鹿特丹评分增加定义为出血恶化的患者与未恶化的患者进行比较。分析了死亡率、神经外科干预需求和血小板输注时机。共纳入243例患者，其中23例（9.5%）出血恶化。血肿恶化的患者损伤严重程度评分、头部简明损伤量表评分、硬膜下血肿发生率、死亡率更高，格拉斯哥昏迷量表评分更低。两组之间血小板输注的分钟数没有显著差异。经过逻辑回归分析，硬膜下血肿的存在和较低的入院格拉斯哥昏迷量表评分是血肿恶化的预测因素，而血小板输注的分钟数仍无显著差异。对于伤前接受抗血小板治疗的创伤性颅内出血患者，血小板输注时机对血肿恶化率没有任何影响。该组血肿恶化的潜在风险因素是硬膜下血肿的存在和较低的入院格拉斯哥昏迷量表评分。
