Agyabeng-Dadzie Kojo, Hunter Jocelyn E, Smith Timothy R, Jordan Monica, Safcsak Karen, Ibrahim Joseph A, Cheatham Michael L, Bhullar Indermeet S
Department of Surgery, Orlando Regional Medical Center, Orlando, FL, USA.
Am Surg. 2020 Jul;86(7):826-829. doi: 10.1177/0003134820940248.
The need to reverse the coagulation impairment caused by chronic antiplatelet agents in traumatic brain injury (TBI) patients with acute traumatic intracerebral hemorrhage (TICH) remains controversial. We sought to determine whether emergent platelet transfusion reduces the incidence of hemorrhage expansion, mortality, or need for neurosurgical intervention such as intracranial pressure (ICP) monitoring, burr holes, or craniotomy.
All adult blunt TICH patients (age ≥16 years) over a 4-year period were retrospectively reviewed. Patients with penetrating TBI, blunt TBI without TICH on admission computed tomography (CT), receiving warfarin, not on antiplatelet agents, or requiring immediate operative intervention were excluded. Patients were divided into 2 groups depending on whether they received a platelet transfusion: reversal group (RV) versus no reversal group (NR). Patient outcomes were analyzed using Mann-Whitney U and Fisher's exact tests.
169 blunt TBI patients on chronic antiplatelet therapy were studied (102 RV group, 67 NR group). The groups were well matched with regard to age, Injury Severity Score, Abbreviated Injury Scale-head, Glasgow Coma Score, mechanism of injury, need for intubation, time to initial CT scan, and hospital length of stay. Immediate platelet transfusion did not alter the occurrence of TICH extension on follow-up CT (26% vs 21%, = .71), TBI-specific mortality (9% vs 13%, = .45), need for ICP monitor (2% vs 3%, = 1.0), burr hole (1% vs 3%, = .56), or craniotomy (1% vs 3%, = .56).
Immediate platelet transfusion is unnecessary in blunt TBI patients on chronic antiplatelet therapy who do not require immediate craniotomy.
对于创伤性脑损伤（TBI）合并急性创伤性脑出血（TICH）的患者，逆转慢性抗血小板药物所致凝血功能障碍的必要性仍存在争议。我们试图确定紧急输注血小板是否能降低出血扩大的发生率、死亡率或神经外科干预（如颅内压（ICP）监测、颅骨钻孔或开颅手术）的需求。
回顾性分析4年间所有成年钝性TICH患者（年龄≥16岁）。排除穿透性TBI患者、入院计算机断层扫描（CT）显示钝性TBI但无TICH的患者、正在接受华法林治疗的患者、未服用抗血小板药物的患者或需要立即手术干预的患者。根据是否接受血小板输注将患者分为两组：逆转组（RV）和未逆转组（NR）。采用Mann-Whitney U检验和Fisher精确检验分析患者预后。
研究了169例接受慢性抗血小板治疗的钝性TBI患者（102例为RV组，67例为NR组）。两组在年龄、损伤严重程度评分、简明损伤定级-头部、格拉斯哥昏迷评分、损伤机制、插管需求、首次CT扫描时间和住院时间方面匹配良好。立即输注血小板并未改变随访CT上TICH扩展的发生率（26%对21%，P = 0.71）、TBI特异性死亡率（9%对13%，P = 0.45）、ICP监测需求（2%对3%，P = 1.0）、颅骨钻孔需求（1%对3%，P = 0.56）或开颅手术需求（1%对3%，P = 0.56）。
对于不需要立即开颅手术的慢性抗血小板治疗的钝性TBI患者，无需立即输注血小板。
