Department of Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy; Department of Anaesthesia and Intensive Care, Bufalini Hospital, Cesena, Italy.
NeuroTrauma Intensive Care Unit, Department of Anaesthesia, Emergency and Critical Care, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.
World Neurosurg. 2020 Sep;141:455-466.e13. doi: 10.1016/j.wneu.2020.03.216. Epub 2020 Apr 11.
The evidence suggests that antiplatelet agents (APA) slightly increase the risk of death and disease progression in patients with traumatic brain injury or spontaneous intracranial hemorrhage (ICH). There is little evidence that APA reversal with platelet (PLT) transfusion may improve the outcome. In this systematic review and meta-analysis, our goal was to evaluate the differences in mortality, severe disability, and hematoma expansion related to PLT transfusion. We retrieved randomized or cohort studies comparing adult patients on APA with traumatic brain injury or ICH who were treated with PLT or not. We calculated the standardized risk difference and 95% confidence interval. A random-effects model was applied to analyze the data. The heterogeneity of the retrieved trials was evaluated through the I statistic. Our review included 16 clinical trials. We observed a significant difference between the 2 groups only for hematoma expansion: risk difference was -0.10 (10%; 95% confidence interval, -0.14 to -0.05; P < 0.0001; I = 0.90) in favor of PLT transfusion. Performing subgroups analyses according to the type of bleeding mechanism, we observed the same results. The use of PLT in patients on APA affected by ICH seemed to have no clear beneficial effect for the outcomes evaluated; conversely, PLT seemed to slightly increase the odds for adverse events of thromboembolic origin, even although not significantly.
有证据表明，抗血小板药物（APA）略微增加了创伤性脑损伤或自发性颅内出血（ICH）患者的死亡和疾病进展风险。几乎没有证据表明血小板（PLT）输注逆转 APA 可能改善结局。在这项系统评价和荟萃分析中，我们的目标是评估 PLT 输注与死亡率、严重残疾和血肿扩大相关的差异。我们检索了比较接受 APA 治疗的创伤性脑损伤或 ICH 成年患者的随机或队列研究，这些患者接受了 PLT 治疗或未接受 PLT 治疗。我们计算了标准化风险差异和 95%置信区间。应用随机效应模型分析数据。通过 I 统计量评估检索试验的异质性。我们的综述包括 16 项临床试验。我们仅观察到两组之间在血肿扩大方面存在显著差异：风险差异为 -0.10（10%；95%置信区间，-0.14 至 -0.05；P < 0.0001；I = 0.90），PLT 输注更有利。根据出血机制的类型进行亚组分析，我们观察到了相同的结果。在接受 APA 治疗的 ICH 患者中使用 PLT 似乎对评估的结局没有明显的有益效果；相反，PLT 似乎略微增加了血栓栓塞性不良事件的几率，尽管没有显著增加。
