长期口服抗血小板治疗的自发性脑出血手术患者围手术期血小板功能监测及血小板输注的作用：一例报告

The role of monitoring platelet function perioperatively and platelet transfusion for operated spontaneous intracerebral hemorrhage patients with long-term oral antiplatelet therapy: A case report.

作者信息

Wang Kaiwen, Liu Qingyuan, Wu Jun, Cao Yong, Wang Shuo

机构信息

Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing 100070, People's Republic of China; China National Clinical Research Center for Neurological Diseases, Beijing, People's Republic of China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People's Republic of China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, People's Republic of China.

出版信息

Int J Surg Case Rep. 2021 Dec;89:106589. doi: 10.1016/j.ijscr.2021.106589. Epub 2021 Nov 10.

DOI:10.1016/j.ijscr.2021.106589

PMID:34844198

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8636801/

Abstract

INTRODUCTION AND IMPORTANCE

Spontaneous intracerebral hemorrhage (SICH) with long-term oral antiplatelet therapy (LOAPT) is known as a dilemma in balancing the risk of postoperative rebleeding and ischemic events because of confused coagulation function. We herein describe a report of perioperative management of spontaneous intracerebral hemorrhage patient on long-term oral antiplatelet therapy.

CASE PRESENTATION

A 42-year-old male patient on long-term oral antiplatelet therapy presented with coma, and he was diagnosed with spontaneous intracerebral hemorrhage. Considering the patient's clinical condition, despite the thromboelastography suggested that the inhibition of platelet function was high preoperatively, an emergency craniectomy were underwent. After platelet transfusion during surgery and taking control of the clotting and platelet function postoperatively, the patient was stable without rebleeding and new ischemic events in perioperative period and recovered satisfactorily.

CLINICAL DISCUSSION

Rare studies have provided evidence for managing operated spontaneous intracerebral hemorrhage patients on long-term oral antiplatelet therapy, and whether platelet transfusion is recommended was controversial. In this case, we presented monitoring and taking control of clotting and platelet function postoperatively would help in preventing rebleeding and ischemic events in such patients; moreover, platelet transfusion may quickly and safely reverse platelet dysfunction for emergency surgery. This case was the first to report platelet function and coagulation function management in spontaneous intracerebral hemorrhage patients with long-term oral antiplatelet therapy.

CONCLUSION

Monitoring and maintaining coagulation and platelet function perioperatively are essential to balance the risk of postoperative rebleeding and ischemic events.

摘要

引言与重要性

长期口服抗血小板治疗（LOAPT）的自发性脑出血（SICH）因凝血功能紊乱，在平衡术后再出血风险和缺血事件方面是一个难题。我们在此描述一例长期口服抗血小板治疗的自发性脑出血患者的围手术期管理报告。

病例介绍

一名长期口服抗血小板治疗的42岁男性患者出现昏迷，被诊断为自发性脑出血。考虑到患者的临床状况，尽管血栓弹力图显示术前血小板功能抑制较高，仍进行了急诊开颅手术。术中输注血小板并在术后控制凝血和血小板功能后，患者在围手术期保持稳定，无再出血和新的缺血事件发生，恢复良好。

临床讨论

关于长期口服抗血小板治疗的自发性脑出血手术患者的管理，鲜有研究提供证据，且是否推荐输注血小板存在争议。在本病例中，我们提出术后监测并控制凝血和血小板功能有助于预防此类患者的再出血和缺血事件；此外，血小板输注可快速、安全地逆转血小板功能障碍，以进行急诊手术。该病例首次报道了长期口服抗血小板治疗的自发性脑出血患者的血小板功能和凝血功能管理。