旋转血小板测量减少了在肝硬化中预防性输血的需要:一项随机对照试验 (NCT:05698134)
Rahul Kumar1,2, Louis X L Ng3, Yu J Wong1,2
1Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
Journal of clinical and experimental hepatology
|October 11, 2024
概括
与标准护理相比,循环血小板测量 (ROTEM) 引导输血显著减少了肝硬化患者接受手术的血液产品使用. 这种粘弹性测试方法降低了输血需求,而不会增加出血风险.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 血液学 血液学 血液学
- 输血医学 输血医学
背景情况:
- 肝硬化会损害血液静止,在侵入性手术期间增加出血风险.
- 传统的凝血测试 (CCT) 在肝硬化中提供有限的全球血液静止评估.
- 粘弹性测试,如旋转血栓收缩仪 (ROTEM),提供血液凝块形成和溶解的全面评估.
研究的目的:
- 为了比较ROTEM引导的血液产品输血与基于CCT的标准护理 (SOC).
- 确定ROTEM指导是否降低了在接受选择性侵入性手术的肝硬化患者的血液产品需求.
- 评估ROTEM指导输血在与程序相关的出血和并发症方面的安全性.
主要方法:
- 一个开放的随机对照试验,涉及40名肝硬化和CCT异常的患者.
- 患者被随机分配,接受由ROTEM或SOC指导的血液制品.
- 主要结局:新鲜冷血 (FFP) 或血小板输血的差异;次要结局:在7天内与手术有关的出血.
主要成果:
- 与SOC组 (100%) 相比,ROTEM组需要输血的数量显著减少 (40%) (P < 0.001).
- 对FFP (P < 0.001) 和血小板 (P = 0.046) 均观察到减少输血需求.
- 没有显著的出血事件发生,与输血相关的不良事件很少发生,并且在不同组之间相似.
结论:
- ROTEM提供了对肝硬化患者血液静止的全球评估.
- 基于ROTEM的输血策略显著降低了接受手术的肝硬化患者的血液产品输血需求.
- 这种方法不会增加出血事件的风险,使其成为安全有效的输血策略.
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