接受血小板输注的创伤性脑损伤且伴有血小板抑制的患者，其神经外科干预需求降低，死亡率也降低。
Traumatic brain injury patients with platelet inhibition receiving platelet transfusion demonstrate decreased need for neurosurgical intervention and decreased mortality.
作者信息
Miles M Victoria P, Hicks R Chace, Parmer Hunter, Brown Caroline, Edwards Abigail, Stewart Kathryn, Gao Lani, Maxwell Robert
机构信息
From the Department of Surgery, University of Tennessee College of Medicine Chattanooga (M.V.P.M., R.C.H., H.P., R.M.), Chattanooga; University of Tennessee College of Medicine (C.B., A.E.), Memphis; Department of Surgery, Erlanger Health System (K.S.); and Department of Mathematics (L.G.), University of Tennessee Chattanooga, Chattanooga, Tennessee.
出版信息
J Trauma Acute Care Surg. 2022 Apr 1;92(4):701-707. doi: 10.1097/TA.0000000000003516.
BACKGROUND
Platelet dysfunction is known to occur in patients with traumatic brain injury (TBI), and the correction of platelet dysfunction may prevent hemorrhagic progression in TBI. Thromboelastography with platelet mapping (TEG-PM; Haemonetics) evaluates the degree of platelet function inhibition through the adenosine diphosphate (ADP) and arachidonic acid (AA) pathways. We hypothesized that ADP and AA inhibition would improve with the transfusion of platelets in patients with TBI.
METHODS
A retrospective review was conducted at a Level I trauma center of all patients presenting with TBI from December 2019 to December 2020. Per a practice management guideline, a platelet mapping assay was obtained on all patients with TBI upon admission. If ADP or AA was found to be inhibited (>60%), the patient was transfused 1 unit of platelets and a repeat platelet mapping assay was ordered. Demographic data, laboratory values, and outcomes were analyzed.
RESULTS
Over the 13-month study period, 453 patients with TBI underwent TEG-PM with a protocol adherence rate of 66.5% resulting in a total of 147 patients who received platelets for ADP and/or AA inhibition; of those, 107 underwent repeat TEG-PM after platelets were administered. With the administration of platelets, ADP (p < 0.0001), AA (p < 0.0001), and MA (p = 0.0002) all significantly improved. Of 330 patients with TBI not taking antiplatelet medications, 50.9% showed inhibition in ADP and/or AA. If AA or ADP inhibition was noted on admission, mortality was increased (p = 0.0108). If ADP improved with platelet administration, the need for neurosurgical intervention was noted to decrease (p = 0.0182).
CONCLUSION
Patients with TBI and platelet inhibition may benefit from the administration of platelets to correct platelet dysfunction. Thromboelastography with platelet mapping may be implemented in the initial workup of patients presenting with TBI to assess platelet dysfunction and provide prognostic information, which may guide treatment.
LEVEL OF EVIDENCE
Therapeutic / Care Management, level III.
背景
已知创伤性脑损伤（TBI）患者会出现血小板功能障碍，纠正血小板功能障碍可能预防TBI患者的出血进展。血小板功能分析的血栓弹力图（TEG-PM；Haemonetics公司）通过二磷酸腺苷（ADP）和花生四烯酸（AA）途径评估血小板功能抑制程度。我们假设，TBI患者输注血小板后，ADP和AA抑制情况会得到改善。
方法
在一家一级创伤中心对2019年12月至2020年12月期间所有TBI患者进行回顾性研究。根据一项实践管理指南，所有TBI患者入院时均进行血小板功能分析检测。如果发现ADP或AA受到抑制（>60%），则给患者输注1单位血小板，并要求再次进行血小板功能分析检测。分析人口统计学数据、实验室检查值和结果。
结果
在为期13个月的研究期间，453例TBI患者接受了TEG-PM检测，方案依从率为66.5%，共有147例患者因ADP和/或AA抑制而接受了血小板输注；其中，107例在输注血小板后再次进行了TEG-PM检测。随着血小板的输注，ADP（p<0.0001）、AA（p<0.0001）和MA（p=0.0002）均显著改善。在330例未服用抗血小板药物的TBI患者中，50.9%的患者显示ADP和/或AA受到抑制。如果入院时发现AA或ADP受到抑制，则死亡率会升高（p=0.0108）。如果ADP在输注血小板后得到改善，则神经外科干预的需求会降低（p=0.0182）。
结论
TBI且存在血小板抑制的患者可能会从输注血小板以纠正血小板功能障碍中获益。血小板功能分析的血栓弹力图可用于TBI患者的初始检查，以评估血小板功能障碍并提供预后信息，从而指导治疗。
证据水平
治疗/护理管理，三级。
Zotero 插件