Variability in the Use of Platelet Transfusion in Patients with Intracerebral Hemorrhage: Observations from the Ethnic/Racial Variations of Intracerebral Hemorrhage Study

被引:10
|
作者
Guerrero, Waldo R. [1 ]
Gonzales, Nicole R. [2 ]
Sekar, Padmini [3 ]
Kawano-Castillo, Jorge [2 ]
Moomaw, Charles J. [3 ]
Worrall, Bradford B. [4 ,5 ]
Langefeld, Carl D. [6 ]
Martini, Sharyl R. [7 ]
Flaherty, Matthew L. [3 ]
Sheth, Kevin N. [8 ]
Osborne, Jennifer [3 ]
Woo, Daniel [3 ]
机构
[1] Univ Iowa, Dept Neurol, Div Intervent Neuroradiol Endovasc Neurosurg, Iowa City, IA 52242 USA
[2] McGovern Med Sch, Houston, TX USA
[3] Univ Cincinnati, Coll Med, Dept Neurol & Rehabil Med, Cincinnati, OH USA
[4] Univ Virginia, Dept Neurol, Charlottesville, VA USA
[5] Univ Virginia, Dept Publ Hlth Sci, Charlottesville, VA USA
[6] Wake Forest Sch Med, Div Publ Hlth Sci, Genom Dept Biostat Sci, Ctr Publ Hlth, Winston Salem, NC USA
[7] Baylor Coll Med, Dept Neurol, Houston, TX 77030 USA
[8] Univ Maryland, Sch Med, Dept Neurol, Baltimore, MD 21201 USA
来源
JOURNAL OF STROKE & CEREBROVASCULAR DISEASES | 2017年 / 26卷 / 09期
关键词
Platelet; intracerebral hemorrhage; transfusion; ERICH; ventriculostomy; outcomes; antiplatelet; ANTIPLATELET THERAPY; INDEPENDENT PREDICTOR; MEDICAL-RECORDS; ACUTE STROKE; GROWTH; ENLARGEMENT; MORTALITY; CARE;
D O I
10.1016/j.jstrokecerebrovasdis.2017.06.014
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
Background: We examined platelet transfusion (PTx) in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study, hypothesizing that rates of PTx would vary among hospitals and depend on whether patients were on an antiplatelet therapy or underwent intracerebral hemorrhage (ICH) surgical treatment. Methods: The ERICH study is a prospective observational study evaluating risk factors for ICH among whites, blacks, and Hispanics. We identified factors associated with PTx, examined practice patterns of PTx across the United States, and explored the association of PTx with mortality and poor outcome (modified Rankin Scale score 4-6). Results: Nineteen centers enrolled 2572 ICH cases; 11.7% received PTx. Factors significantly associated with PTx were antiplatelet use before onset (odds ratio [OR], 5.02; 95% confidence interval [CI], 3.81-6.61, P <.0001), thrombocytopenia (OR, 13.53; 95% CI, 8.43-21.72, P <.0001), and ventriculostomy placement (OR, 1.85; 95% CI, 1.36-2.52, P <.0001). Blacks were less likely (OR,.57; 95% CI,.41-0.80) to receive PTx. Among patients who received PTx, 42.4% were not on an antiplatelet therapy before onset. Twenty-three percent of patients on antiplatelet therapy received PTx, but percentages varied from 0% to 71% across centers. There was no difference in mortality or poor outcome at 3 months between patients receiving PTx and those who did not. Conclusions: The frequency of PTx for ICH varies across academic centers. Thrombocytopenia, antiplatelet use, vascular risk factors, and ventriculostomy placement were associated with PTx. PTx was not associated with improved outcomes. We anticipate reduced PTx use over time given recent clinical trial data suggesting its use could be harmful; however, the issue of whether surgical management warrants PTx remains. (C) 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:1974 / 1980
页数:7
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