Morris Nicholas A, Patel Nikhil, Galvagno Samuel M, Ludeman Emilie, Schwartzbauer Gary T, Pourmand Ali, Tran Quincy K
Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States of America; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States of America.
Department of Critical Care, Carolinas HealthCare System, Charlotte, NC, United States of America.
J Neurol Sci. 2020 Oct 15;417:117075. doi: 10.1016/j.jns.2020.117075. Epub 2020 Aug 1.
The practice of platelet transfusion to mitigate the deleterious effects of antiplatelet agents on spontaneous intracerebral hemorrhage (ICH) remains common. However, the effect of antiplatelet agents on patients with ICH is still controversial and transfusing platelets is not without risk. We performed a meta-analysis in order to determine the effect of platelet transfusion on antiplatelet agent associated ICH.
We queried PubMed, Embase, and Scopus databases to identify cohort studies, case-control studies, and randomized control trials. Study quality was graded by the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool, as appropriate. Outcomes of interest included functional independence as measured by the modified Rankin Scale and mortality. We compared patients with antiplatelet agent associated ICH who received platelet transfusion to those that did not.
We identified 625 articles. After reviewing 44 full text articles, 5 were deemed appropriate for meta-analysis, including 4 cohort studies and one randomized control trial. Considerable heterogeneity was present among the studies (I > 81% for all analyses). We did not find a significant effect of platelet transfusions on functional independence (Odds Ratio [OR] 1.3, 95% CI.0.45-3.9) or mortality (OR 0.58, 95% Confidence Interval [CI] 0.12-2.6).
We found no evidence for an effect of platelet transfusions on functional independence or mortality following antiplatelet associated ICH. More randomized trials are needed to evaluate platelet transfusion in patients with ICH and proven reduced platelet activity or those requiring neurosurgical intervention.
输注血小板以减轻抗血小板药物对自发性脑出血（ICH）的有害影响的做法仍然很常见。然而，抗血小板药物对ICH患者的影响仍存在争议，且输注血小板并非没有风险。我们进行了一项荟萃分析，以确定血小板输注对抗血小板药物相关ICH的影响。
我们检索了PubMed、Embase和Scopus数据库，以识别队列研究、病例对照研究和随机对照试验。根据情况，研究质量由纽卡斯尔-渥太华量表和Cochrane偏倚风险工具进行分级。感兴趣的结果包括通过改良Rankin量表测量的功能独立性和死亡率。我们将接受血小板输注的抗血小板药物相关ICH患者与未接受输注的患者进行了比较。
我们识别出625篇文章。在审查了44篇全文文章后，5篇被认为适合进行荟萃分析，包括4项队列研究和1项随机对照试验。研究之间存在相当大的异质性（所有分析的I>81%）。我们没有发现血小板输注对功能独立性（优势比[OR]1.3，95%置信区间[CI]0.45-3.9）或死亡率（OR 0.58，95%置信区间[CI]0.12-2.6）有显著影响。
我们没有发现证据表明血小板输注对抗血小板相关ICH后的功能独立性或死亡率有影响。需要更多的随机试验来评估在ICH患者中以及已证实血小板活性降低或需要神经外科干预的患者中进行血小板输注的情况。
