Effects of platelet dysfunction and platelet transfusion on outcomes in traumatic brain injury patients
Effects of platelet dysfunction and platelet transfusion on outcomes in traumatic brain injury patients
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DOI：
10.1080/02699052.2018.1536805
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发表时间：
2018-12-06
期刊：
影响因子：
1.9
通讯作者：
Litofsky, N. Scott
中科院分区：
文献类型：
--
作者：
Guillotte, Andrew R.;Herbert, Joseph P.;Litofsky, N. Scott
目的：创伤性脑损伤(TBI)患者的血小板抑制可能与损伤或伤前应用抗血小板药物有关。本研究旨在确定与增加血小板花生四烯酸(AA)和二磷酸腺苷(ADP)抑制相关的因素，并确定血小板输注是否会减少血小板功能障碍并影响预后。方法：对CT诊断为颅脑损伤的成人患者进行前瞻性血栓弹性成像(TEG)检查。结果包括住院死亡率和CT病变扩大。结果：在153例患者中，中、重度脑损伤患者的腺苷二磷酸抑制程度高于轻度脑损伤患者(p=0.0011)。P2Y12抑制药对腺苷二磷酸的抑制作用增强(p=0.0077)。入院时抑制ADP与住院死亡率(p=0.24)或CT病变扩大(p=0.94)无关。输注血小板对腺苷二磷酸的抑制程度(-15.1%)比不输注(+11.7%)的平均降低程度无统计学差异(p=0.0472)。结论：与中、重度脑损伤相比，轻度脑损伤对ADP的抑制作用较轻，提示脑损伤的严重程度与血小板功能障碍程度之间存在剂量反应关系。此外，有必要对脑外伤患者输注血小板的疗效和参数进行研究。
Objective: Platelet inhibition in traumatic brain injury (TBI) may be due to injury or antiplatelet medication use pre-injury. This study aims to identify factors associated with increased platelet arachidonic acid (AA) and adenosine diphosphate (ADP) inhibition and determine if platelet transfusion reduces platelet dysfunction and affects outcome. Methods: Prospective thromboelastography (TEG) assays were collected on adult patients with TBI with intracranial injuries detected by computed tomography (CT). Outcomes included in-hospital mortality, and CT lesion expansion. Results: Of 153 patients, ADP inhibition was increased in moderate and severe TBI compared to mild TBI (p = 0.0011). P2Y12 inhibiting medications had increased ADP inhibition (p = 0.0077). Admission ADP inhibition was not associated with in-hospital mortality (p = 0.24) or CT lesion expansion (p = 0.94). Mean reduction of ADP inhibition from platelet transfusion (-15.1%) relative to no transfusion (+ 11.7%) was not statistically different (p = 0.0472). Conclusions: Mild TBI results in less ADP inhibition compared to moderate and severe TBI, suggesting a dose response relationship between TBI severity and degree of platelet dysfunction. Further, study is warranted to determine efficacy and parameters for platelet transfusion in patients with TBI.