Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality
Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality
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DOI：
10.1182/blood-2014-10-605493
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发表时间：
2015-02-26
期刊：
影响因子：
20.3
通讯作者：
Tobian, Aaron A. R.
中科院分区：
文献类型：
--
作者：
Goel, Ruchika;Ness, Paul M.;Tobian, Aaron A. R.
虽然血小板是止血的主要介质，但有新的证据表明，它们也可能介导病理性血栓形成。关于血栓性血小板减少性紫癜（TTP）、肝素诱导的血小板减少症（HIT）和免疫性血小板减少性紫癜（ITP）与血小板输注相关的风险和获益的数据很少。本研究利用全国住院患者样本评价了当前住院血小板输注实践及其与动脉/静脉血栓形成、急性心肌梗死（AMI）、卒中和5年（2007-2011年）住院死亡率的相关性。计算与血小板输注相关的年龄和性别校正比值比（adjOR）。有10624例TTP住院; 6332例HIT住院和79980例ITP住院。10.1%的TTP、7.1%的HIT和25.8%的ITP住院患者报告了血小板输注。TTP患者的血小板输注与动脉血栓形成（adjOR = 5.8，95%CI = 1.3-26.6）、AMI（adjOR = 52.0，95%CI = 1.2-3.3）和死亡率（adjOR = 2.0，95%CI = 1.3-3.0）的几率较高相关，但与静脉血栓形成无关。HIT患者的血小板输注与动脉血栓形成（adjOR = 3.4，95%CI = 1.2-9.5）和死亡率（adjOR = 5.2，95%CI = 2.6-10.5）的几率较高相关，但与静脉血栓形成无关。除AMI外，在调整临床严重程度和急性程度后，所有相关性仍然显著。与ITP无显著相关性。血小板输注与TTP和HIT患者动脉血栓形成和死亡率的几率较高相关。
While platelets are primary mediators of hemostasis, there is emerging evidence to show that they may also mediate pathologic thrombogenesis. Little data are available on risks and benefits associated with platelet transfusions in thrombotic thrombocytopenic purpura (TTP), heparin-induced thrombocytopenia (HIT) and immune thrombocytopenic purpura (ITP). This study utilized the Nationwide Inpatient Sample to evaluate the current in-hospital platelet transfusion practices and their association with arterial/venous thrombosis, acute myocardial infarction (AMI), stroke, and in-hospital mortality over 5 years (2007-2011). Age and gender-adjusted odds ratios (adjOR) associated with platelet transfusions were calculated. There were 10 624 hospitalizations with TTP; 6332 with HIT and 79 980 with ITP. Platelet transfusions were reported in 10.1% TTP, 7.1% HIT, and 25.8% ITP admissions. Platelet transfusions in TTP were associated with higher odds of arterial thrombosis (adjOR = 5.8, 95%CI = 1.3-26.6), AMI (adjOR 5 2.0, 95%CI = 1.2-3.3) and mortality (adjOR = 2.0,95%CI = 1.3-3.0), but not venous thrombosis. Platelet transfusions in HIT were associated with higher odds of arterial thrombosis (adjOR = 3.4, 95%CI = 1.2-9.5) and mortality (adjOR = 5.2, 95%CI = 2.6-10.5) but not venous thrombosis. Except for AMI, all relationships remained significant after adjusting for clinical severity and acuity. No associations were significant for ITP. Platelet transfusions are associated with higher odds of arterial thrombosis and mortality among TTP and HIT patients.