Current Controversy on Platelets and Patent Ductus Arteriosus Closure in Preterm Infants.
Current Controversy on Platelets and Patent Ductus Arteriosus Closure in Preterm Infants.
复制标题
早产儿血小板减少症和动脉未闭闭合术的当前争议。
DOI：
10.3389/fped.2021.612242
复制
发表时间：
2021
影响因子：
2.6
通讯作者：
Shelton EL
中科院分区：
文献类型：
--
作者：
Sallmon H;Timme N;Atasay B;Erdeve Ö;Hansmann G;Singh Y;Weber SC;Shelton EL
血小板在小鼠动脉导管未闭（PDA）闭合中起关键作用。到目前为止，这些发现在人类早产儿PDA的临床意义仍有争议。我们讨论了血小板在早产儿PDA闭合中的作用的现有研究数据：关于血小板减少是否导致自发性导管闭合失败，几项大多数回顾性研究得出了相互矛盾的结果。这同样适用于研究血小板减少症作为环氧合酶抑制剂药物治疗动脉导管闭合不成功的风险因素的作用。尽管如此，最近的荟萃分析得出结论，血小板减少症是早产儿PDA自发和药物封堵失败的独立风险因素。然而，现有的调查在患者特征，诊断策略和治疗方案方面有所不同。一些研究表明，血小板功能受损而不是血小板数量是早产儿动脉导管闭合失败的关键因素。最近一项关于PDA早产儿血小板输注的随机对照试验未能显示自由输注阈值与限制输注阈值对PDA闭合率的任何益处。重要的是，大量输血与脑室内出血的发生率增加有关，因此应该避免。总之，现有证据表明，血小板减少症和血小板功能障碍导致早产儿PDA自发性和药物闭合失败。然而，这些血小板对PDA的影响似乎只有中等的临床意义。此外，血小板减少的早产儿为了促进PDA闭合而输注血小板似乎弊大于利。
Platelets are critically involved in murine patent ductus arteriosus (PDA) closure. To date, the clinical significance of these findings in human preterm infants with PDA is still controversial. We discuss the available study data on the role of platelets for PDA closure in preterm infants: Several mostly retrospective studies have yielded conflicting results on whether thrombocytopenia contributes to failed spontaneous ductal closure. The same applies to investigations on the role of thrombocytopenia as a risk factor for unsuccessful ductus arteriosus closure by pharmacological treatment with cyclooxygenase inhibitors. Nonetheless, recent meta-analyses have concluded that thrombocytopenia constitutes an independent risk factor for both failed spontaneous and pharmacological PDA closure in preterm infants. However, the available investigations differ in regard to patient characteristics, diagnostic strategies, and treatment protocols. Several studies suggest that impaired platelet function rather than platelet number is critically involved in failure of ductus arteriosus closure in the preterm infant. A recent randomized-controlled trial on platelet transfusions in preterm infants with PDA failed to show any benefit for liberal vs. restrictive transfusion thresholds on PDA closure rates. Importantly, liberal transfusions were associated with an increased rate of intraventricular hemorrhage, and thus should be avoided. In conclusion, the available evidence suggests that thrombocytopenia and platelet dysfunction contribute to failure of spontaneous and pharmacological PDA closure in preterm infants. However, these platelet effects on PDA seem to be of only moderate clinical significance. Furthermore, platelet transfusions in thrombocytopenic preterm infants in order to facilitate PDA closure appear to cause more harm than good.
登录
查看更多内容
影响因子：
2.5
作者：
Dizdar, Evrim Alyamac;Ozdemir, Ramazan;Dilmen, Ugur
通讯作者：
Dilmen, Ugur
影响因子：
5.6
作者：
Hou, Hai-Tao;Xi-Zhang;He, Guo-Wei
通讯作者：
He, Guo-Wei
影响因子：
2.7
作者：
Bekmez, Buse Ozer;Tayman, Cuneyt;Derme, Turan
通讯作者：
Derme, Turan
影响因子：
82.9
作者：
Echtler, Katrin;Stark, Konstantin;Massberg, Steffen
通讯作者：
Massberg, Steffen
影响因子：
2.5
作者：
Ghirardello, Stefano;Raffaeli, Genny;Mosca, Fabio
通讯作者：
Mosca, Fabio