Early platelet transfusion improves platelet activity and may improve outcomes after intracerebral hemorrhage.
Early platelet transfusion improves platelet activity and may improve outcomes after intracerebral hemorrhage.
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DOI：
10.1007/s12028-011-9619-3
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发表时间：
2012-02
影响因子：
3.5
通讯作者：
Kwaan HC
中科院分区：
文献类型：
--
作者：
Naidech AM;Liebling SM;Rosenberg NF;Lindholm PF;Bernstein RA;Batjer HH;Alberts MJ;Kwaan HC
在急性脑出血（ICH）患者中，入院时血小板活性降低预示出血增长和不良结局。我们检验了血小板输注可改善血小板活性的假设。此外，我们假设，早期治疗出血增长和预后不良的高风险患者将减少随访出血量和不良临床预后。我们前瞻性地确定了入院时血小板活性降低并接受血小板输注的连续ICH患者。我们根据既往发表的文献、血小板活性降低或已知的抗血小板治疗（APT）和症状发作后12小时内的诊断性CT定义了高危患者。在3个月时，使用VerifyNow-ASA（Accumetrics，CA）测量血小板活性，使用计算机定量技术测量CT上的ICH体积，使用改良兰金量表（mRS）测量功能结局。45例患者接受血小板输注，血小板活性从472 ± 50（与阿司匹林效应一致）增加至561 ± 92阿司匹林反应单位（与无阿司匹林效应一致，P < 0.001）。对于高危患者，在症状发作后12小时内输注血小板，而不是>12小时，与较小的随访出血量相关（8.4 [3-17.4] vs. 13.8 [12.3-62.5] ml，P = 0.04）和3个月时独立性（mRS < 4）的几率增加（20例中有11例vs. 7例中有0例，P = 0.01）。已知APT患者的结果相似。在出血增长和预后不良的高危患者中，早期血小板输注可改善血小板活性测定结果，并与3个月时最终出血量较小和更独立相关。
In patients with acute intracerebral hemorrhage (ICH), reduced platelet activity on admission predicts hemorrhage growth and poor outcomes. We tested the hypotheses that platelet transfusion improves measured platelet activity. Further, we hypothesized that earlier treatment in patients at high risk for hemorrhage growth and poor outcome would reduce follow-up hemorrhage size and poor clinical outcomes. We prospectively identified consecutive patients with ICH who had reduced platelet activity on admission and received a platelet transfusion. We defined high-risk patients as per a previous publication, reduced platelet activity, or known anti-platelet therapy (APT) and the diagnostic CT within 12 h of symptom onset. Platelet activity was measured with the VerifyNow-ASA (Accumetrics, CA), ICH volumes on CT with computerized quantitative techniques, and functional outcomes with the modified Rankin Scale (mRS) at 3 months. Forty-five patients received a platelet transfusion with an increase in platelet activity from 472 ± 50 (consistent with an aspirin effect) to 561 ± 92 aspirin reaction units (consistent with no aspirin effect, P < 0.001). For high-risk patients, platelet transfusion within 12 h of symptom onset, as opposed to >12 h, was associated with smaller follow-up hemorrhage size (8.4 [3–17.4] vs. 13.8 [12.3–62.5] ml, P = 0.04) and increased odds of independence (mRS < 4) at 3 months (11 of 20 vs. 0 of 7, P = 0.01). There were similar results for patients with known APT. In patients at high risk for hemorrhage growth and poor outcome, early platelet transfusion improved platelet activity assay results and was associated with smaller final hemorrhage size and more independence at 3 months.
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影响因子：
8.8
作者：
Vlaar, Alexander P. J.;Binnekade, Jan M.;Juffermans, Nicole P.
通讯作者：
Juffermans, Nicole P.
影响因子：
39.2
作者：
Goldenberg, NA;Jacobson, L;Manco-Johnson, MJ
通讯作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
158.5
作者：
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通讯作者：
Steiner, Thorsten