The association between platelet transfusions and bleeding in critically ill patients with thrombocytopenia.
The association between platelet transfusions and bleeding in critically ill patients with thrombocytopenia.
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DOI：
10.1002/rth2.12004
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发表时间：
2017-07
影响因子：
4.6
通讯作者：
PROTECT Investigators, the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group
中科院分区：
文献类型：
--
作者：
Arnold DM;Lauzier F;Albert M;Williamson D;Li N;Zarychanski R;Doig C;McIntyre L;Freitag A;Crowther M;Saunders L;Clarke F;Bellomo R;Qushmaq I;Lopes RD;Heels-Ansdell D;Webert K;Cook D;PROTECT Investigators, the Canadian Critical Care Trials Group and the Australian and New Zealand Intensive Care Society Clinical Trials Group
血小板输注通常用于治疗患有血小板减少症的危重患者。目前尚不清楚输注血小板是否与降低大出血风险有关。观察性队列研究嵌套在先前重症监护病房(ICU)的多中心随机血栓预防试验中。研究的目的是评估血小板输注与判定的重大出血事件之间的关系。回顾了血小板输注事件的给药时机、产品类型和剂量。根据血小板减少的严重程度、抗血小板药物的使用、手术和其他协变量对输注和不输注血小板的大出血进行了调整。次要结果是血栓形成、在ICU的死亡和血小板计数增加。在2256例患者中，71例(3.1%)接受了190次血小板输注。其中，121例(63.7%)用于54例无出血、血小板减少的患者。在接受和不接受血小板输注的情况下，调整后的大出血发生率没有统计学差异(输血患者的风险比为0.85；95%可信区间为0.42-1.72)。在调整后的分析中，我们没有发现血小板输注与ICU中血栓形成或死亡之间的显著关联。血小板减少、贫血、大出血或轻微出血及抗凝剂的使用与血小板输注有关。输血后3.5h血小板中位数增加20×10~9/L。接受和没有接受血小板输注的患者的大出血发生率没有差别。由于输血患者数量较少，因此推论受到限制。需要临床试验来更好地研究输注血小板对这一高危人群的潜在止血益处和潜在危害。
Platelet transfusions are commonly used to treat critically ill patients with thrombocytopenia. Whether platelet transfusions are associated with a reduction in the risk of major bleeding is unknown. Observational cohort study nested in a previous multicenter, randomized thromboprophylaxis trial in the intensive care unit (ICU). The objective was to evaluate the association between platelet transfusions and adjudicated major bleeding events. Platelet transfusion episodes were reviewed for timing of administration, product type, and dose. Major bleeding with and without platelet transfusions was adjusted for severity of thrombocytopenia, use of anti‐platelet agents, surgery and other covariates. Secondary outcomes were thrombosis, death in ICU and platelet count increment. Among 2,256 patients, 71 (3.1%) received 190 platelet transfusions. Of those, 121 (63.7%) were administered to 54 non‐bleeding, thrombocytopenic patients. Adjusted rates of major bleeding were not statistically different with or without the administration of platelet transfusions (hazard ratio for transfused patients 0.85; 95% confidence interval, 0.42‐1.72). We did not find a significant association between platelet transfusion use and thrombosis or death in ICU in adjusted analyses. Thrombocytopenia, anemia, major or minor bleeding and use of anticoagulants were associated with platelet transfusion administration. The median post‐transfusion platelet count increment was 20×109/L at 3.5 hours post‐transfusion. Rates of major bleeding were not different for patients who did and did not receive platelet transfusions. Inferences were limited by the small number of transfused patients. Clinical trials are needed to better investigate the potential hemostatic benefit and potential harms of platelet transfusions for this high‐risk population.
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