创伤性脑损伤中血小板抑制和功能障碍的快速检测：一项前瞻性观察性研究。
Rapid detection of platelet inhibition and dysfunction in traumatic brain injury: A prospective observational study.
机构信息
From the Department of Surgery (J.A., M.Z., A.H., H.P., M.D.N.), University of Pittsburgh Medical Center; University of Pittsburgh School of Medicine (I.C.), Pittsburgh, Pennsylvania; Department of Surgery (J.O.J.), University of Alabama at Birmingham, Birmingham, Alabama; and Department of Neurological Surgery (D.O.O.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
出版信息
J Trauma Acute Care Surg. 2022 Jan 1;92(1):167-176. doi: 10.1097/TA.0000000000003427.
BACKGROUND
Rapid platelet function testing is frequently used to determine platelet function in patients with traumatic intracranial hemorrhage (tICH). Accuracy and clinical significance of decreased platelet response detected by these tests is not well understood. We sought to determine whether VerifyNow and whole blood aggregometry (WBA) can detect poor platelet response and to elucidate its clinical significance for tICH patients.
METHODS
We prospectively enrolled patients with isolated tICH between 2018 and 2020. Demographics, medical history, injury characteristics, and patient outcomes were recorded. Platelet function was determined by VerifyNow and WBA testing at the time of arrival to the trauma bay and 6 hours later.
RESULTS
A total of 221 patients were enrolled, including 111 patients on no antiplatelet medication, 78 on aspirin, 6 on clopidogrel, and 26 on aspirin and clopidogrel. In the trauma bay, 29.7% and 67.7% of patients on no antiplatelet medication had poor platelet response on VerifyNow and WBA, respectively. Among patients on aspirin, 72.2% and 82.2% had platelet dysfunction on VerifyNow and WBA. Among patients on clopidogrel, 67.9% and 88.9% had platelet dysfunction on VerifyNow and WBA. Patients with nonresponsive platelets had similar in-hospital mortality (3 [3.0%] vs. 6 [6.3%], p = 0.324), tICH progression (26 [27.1%] vs. 24 [26.1%], p = 0.877), intensive care unit admission rates (34 [34.3%] vs. 38 [40.0%), p = 0.415), and length of stay (3 [interquartile range, 2-8] vs. 3.2 [interquartile range, 2-7], p = 0.818) to those with responsive platelets. Platelet transfusion did not improve platelet response or patient outcomes.
CONCLUSION
Rapid platelet function testing detects a highly prevalent poor platelet response among patients with tICH, irrespective of antiplatelet medication use. VerifyNow correlated fairly with whole blood aggregometry among patients with tICH and platelet responsiveness detectable by these tests did not correlate with clinical outcomes. In addition, our results suggest that platelet transfusion may not improve clinical outcomes in patients with tICH.
LEVEL OF EVIDENCE
Diagnostic tests, level II.
背景
快速血小板功能检测常用于确定创伤性颅内出血（tICH）患者的血小板功能。这些检测方法检测到的血小板反应降低的准确性和临床意义尚不清楚。我们旨在确定 VerifyNow 和全血聚集仪（WBA）是否可检测到血小板反应不良，并阐明其对 tICH 患者的临床意义。
方法
我们前瞻性纳入了 2018 年至 2020 年期间孤立性 tICH 患者。记录了患者的人口统计学、病史、损伤特征和患者结局。在创伤室和 6 小时后，通过 VerifyNow 和 WBA 检测来确定血小板功能。
结果
共纳入 221 例患者，其中 111 例患者未服用抗血小板药物，78 例患者服用阿司匹林，6 例患者服用氯吡格雷，26 例患者服用阿司匹林和氯吡格雷。在创伤室，未服用抗血小板药物的患者中，分别有 29.7%和 67.7%的患者 VerifyNow 和 WBA 检测结果显示血小板反应不良。服用阿司匹林的患者中，分别有 72.2%和 82.2%的患者 VerifyNow 和 WBA 检测结果显示血小板功能障碍。服用氯吡格雷的患者中，分别有 67.9%和 88.9%的患者 VerifyNow 和 WBA 检测结果显示血小板功能障碍。无反应性血小板患者的住院死亡率（3[3.0%] vs. 6[6.3%]，p=0.324）、tICH 进展（26[27.1%] vs. 24[26.1%]，p=0.877）、重症监护病房收治率（34[34.3%] vs. 38[40.0%]，p=0.415）和住院时间（3[四分位距，2-8] vs. 3.2[四分位距，2-7]，p=0.818）与反应性血小板患者相似。血小板输注并未改善血小板反应或患者结局。
结论
快速血小板功能检测可检测出 tICH 患者中普遍存在的血小板反应不良，无论是否使用抗血小板药物。VerifyNow 与 tICH 患者的全血聚集仪相关性较好，而这些检测方法检测到的血小板反应性与临床结局无相关性。此外，我们的结果表明，血小板输注可能不会改善 tICH 患者的临床结局。
证据水平
诊断性试验，Ⅱ级。
Zotero 插件