颅内出血患者血小板减少症与临床结局的关系：一项回顾性多中心队列研究。
Thrombocytopenia and Clinical Outcomes in Intracerebral Hemorrhage: A Retrospective Multicenter Cohort Study.
机构信息
Department of Neurology (A.M., M.I.S., S.T.G., J.A.S., J.B.K., H.B.H.), University of Erlangen-Nuremberg, Germany.
Department of Neuroradiology (S.L., H.L.), University of Erlangen-Nuremberg, Germany.
出版信息
Stroke. 2021 Jan;52(2):611-619. doi: 10.1161/STROKEAHA.120.031478. Epub 2021 Jan 12.
BACKGROUND AND PURPOSE
The impact of platelets on hematoma enlargement (HE) of intracerebral hemorrhage (ICH) is not yet sufficiently elucidated. Especially the role of reduced platelet counts on HE and clinical outcomes is still poorly understood. This study investigated the influence of thrombocytopenia on HE, functional outcome, and mortality in patients with ICH with or without prior antiplatelet therapy (APT).
METHODS
Individual participant data of multicenter cohort studies (multicenter RETRACE program [German-Wide Multicenter Analysis of Oral Anticoagulation-Associated Intracerebral Hemorrhage] and single-center UKER-ICH registry [Universitätsklinikum Erlangen Cohort of Patients With Spontaneous ICH]) were grouped into APT and non-APT ICH patients according to the platelet count, that is, with or without thrombocytopenia (cells <150×10/L). Of all patients, 51.5% (1124 of 2183) were on vitamin K antagonist. Imbalances in baseline characteristics including proportions of vitamin K antagonist patients were addressed using propensity score matching. Outcome analyses included HE (>33%), as well as mortality and functional outcome, after 3 months using the modified Rankin Scale, dichotomized into favorable (modified Rankin Scale score, 0-3) and unfavorable (modified Rankin Scale score, 4-6).
RESULTS
Of overall 2252 ICH patients, 11.4% (52 of 458) under APT and 14.0% (242 of 1725) without APT presented with thrombocytopenia on admission. The proportion of patients with HE was not significantly different between patients with or without thrombocytopenia among APT and non-APT ICH patients after propensity score matching (HE: APT patients: 9 of 40 [22.5%] thrombocytopenia versus 27 of 115 [23.5%] nonthrombocytopenia, =0.89; non-APT patients: 54 of 174 [31.0%] thrombocytopenia versus 106 of 356 [29.8%] nonthrombocytopenia, =0.77). In both (APT and non-APT) propensity score matching cohorts, there were no significant differences regarding functional outcome. Mortality after 3 months did not differ among non-APT patients, whereas the mortality rate was significantly higher for APT patients with thrombocytopenia versus APT patients with normal platelet count (APT: 29 of 46 [63.0%] thrombocytopenia versus 58 of 140 [41.4%] nonthrombocytopenia, =0.01; non-APT: 95 of 227 [41.9%] thrombocytopenia versus 178 of 455 [39.1%] nonthrombocytopenia, =0.49).
CONCLUSIONS
Our study implies that thrombocytopenia does not affect rates of HE and functional outcome among ICH patients, neither in patients with nor without APT. In light of increased mortality, the significance of platelet transfusions for ICH patients with thrombocytopenia and previous APT should be explored in future studies.
背景与目的
血小板对颅内出血（ICH）血肿扩大（HE）的影响尚未充分阐明。特别是血小板计数降低对 HE 和临床结局的影响仍知之甚少。本研究调查了血小板减少症对有或无抗血小板治疗（APT）的 ICH 患者 HE、功能结局和死亡率的影响。
方法
根据血小板计数（即有或无血小板减少症[细胞 <150×10/L]），将多中心队列研究（多中心 RETRACE 计划[德国广泛的口服抗凝剂相关脑出血多中心分析]和单中心 UKER-ICH 登记处[埃朗根大学自发性脑出血患者队列]）的个体参与者数据分组为 APT 和非 APT ICH 患者。所有患者中有 51.5%（2183 例中的 1124 例）正在服用维生素 K 拮抗剂。使用倾向评分匹配来解决基线特征（包括维生素 K 拮抗剂患者的比例）的不平衡。结局分析包括 3 个月时采用改良 Rankin 量表评估的 HE（>33%）以及死亡率和功能结局，将改良 Rankin 量表评分分为有利（改良 Rankin 量表评分 0-3）和不利（改良 Rankin 量表评分 4-6）。
结果
在总共 2252 例 ICH 患者中，11.4%（458 例中的 52 例）在 APT 下和 14.0%（1725 例中的 242 例）无 APT 入院时出现血小板减少症。在 APT 和非 APT ICH 患者中，血小板减少症患者和非血小板减少症患者的 HE 发生率在倾向评分匹配后无显著差异（HE：APT 患者：血小板减少症患者 9 例[22.5%]与非血小板减少症患者 27 例[23.5%]，=0.89；非 APT 患者：血小板减少症患者 54 例[31.0%]与非血小板减少症患者 106 例[29.8%]，=0.77）。在两个（APT 和非 APT）倾向评分匹配队列中，功能结局均无显著差异。非 APT 患者的 3 个月死亡率无差异，而 APT 血小板减少症患者的死亡率明显高于 APT 血小板计数正常的患者（APT：血小板减少症患者 29 例[63.0%]与血小板计数正常的患者 58 例[41.4%]，=0.01；非 APT：血小板减少症患者 95 例[41.9%]与血小板计数正常的患者 178 例[39.1%]，=0.49）。
结论
本研究表明，血小板减少症不会影响 ICH 患者的 HE 和功能结局，无论是在有 APT 还是无 APT 的患者中。鉴于死亡率增加，未来的研究应探讨血小板输注对有 APT 和血小板减少症的 ICH 患者的意义。
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