The Effect of Platelet and Desmopressin Administration on Early Radiographic Progression of Traumatic Intracranial Hemorrhage
The Effect of Platelet and Desmopressin Administration on Early Radiographic Progression of Traumatic Intracranial Hemorrhage
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DOI：
10.1089/neu.2014.3728
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发表时间：
2015-11-15
影响因子：
4.2
通讯作者：
Plurad, David
中科院分区：
文献类型：
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作者：
Kim, Dennis Yong;O'Leary, Michael;Plurad, David
关于使用止血剂治疗创伤性颅内出血（tICH）进展的数据有限。本研究的目的是检查血小板输注和去氨加压素（DDAVP）给药对tICH后出血进展的影响。我们假设血小板和DDAVP给药不会导致早期出血进展减少。我们对一级创伤中心数据库进行了一项为期三年的回顾性分析，以确定所有成人钝性tICH患者。主要结局是早期（4小时）放射学出血进展。次要结局包括死亡率、手术干预频率和并发症。进行多元逻辑回归分析，以确定出血进展和死亡率的预测因子。还进行了倾向评分分析，以尽量减少差异，提高接受血小板和DDAVP的患者与未接受血小板和DDAVP的患者之间的可比性。在408例符合入选标准的tICH患者中，126例接受了血小板和DDAVP（P/D [+]），282例未接受（P/D [-]）。总体而言，37%的患者表现出早期放射学出血进展。在单变量分析中，两组间出血进展的发生率无差异（43.7% [P/D（+）] vs. 34.2% [P/D（-）]; p = 0.07）。在多变量分析中，血小板和DDAVP给药与出血进展风险降低（比值比[OR] = 1.40，置信区间[CI] = 0.80-2.40; p = 0.2）或死亡率降低（OR = 1.50，CI = 0.60-4.30; p = 0.4）无关。血小板和DDAVP给药与tICH患者早期放射学出血进展风险降低无关。可能需要在tICH患者中对这些潜在止血药物进行进一步的前瞻性研究。
Limited data exist regarding the use of hemostatic adjuncts on the progression of traumatic intracranial hemorrhage (tICH). The objective of this study was to examine the impact of platelet transfusion and desmopressin (DDAVP) administration on hemorrhage progression following tICH. We hypothesized that platelet and DDAVP administration would not result in decreased early hemorrhagic progression. We performed a three-year retrospective analysis of a Level 1 trauma center database to identify all adult patents with blunt tICH. The primary outcome was early (4 hours) radiographic hemorrhagic progression. Secondary outcomes included mortality, frequency of operative interventions, and complications. Multiple logistic regression analysis was performed to identify predictors for hemorrhage progression and mortality. A propensity score analysis also was performed to minimize differences and improve comparability between patients who received platelets and DDAVP and those who did not. Of 408 patients with tICH meeting the inclusion criteria, 126 received platelets and DDAVP (P/D [+]) and 282 did not (P/D [-]). Overall, 37% of patients demonstrated early radiographic hemorrhage progression. On univariate analysis, there was no difference in the incidence of hemorrhage progression between groups (43.7% [P/D (+)] vs. 34.2% [P/D (-)]; p = 0.07). On multivariate analyses, platelet and DDAVP administration was not associated with either a decreased risk of hemorrhage progression (odds ratio [OR] = 1.40, confidence interval [CI] = 0.80-2.40; p = 0.2) or mortality (OR = 1.50, CI = 0.60-4.30; p = 0.4). The administration of platelets and DDAVP is not associated with a decreased risk for early radiographic hemorrhage progression in patients with tICH. Further prospective study of these potentially hemostatic adjuncts in patients with tICH is potentially warranted.