新英格兰:早产儿应何时采取血小板输注治疗?

创作:Epi汪 审核:Epi汪 02月01日
纳入660名<34周早产,并且发生血小板减低症的新生儿,随机分为高阈值组(低于5万/mm3则采取血小板输注治疗)和低阈值组(2.5万/mm3);
高阈值组中90%的新生儿至少接受一次血小板输注治疗,而低阈值组只有53%;
高/低阈值组新生儿在分组后28天内出现新的大出血或者死亡事件的发生率分别为26%和19%,高阈值组的发生风险是低阈值组的1.57倍;
两组其他严重不良事件发生率没有统计学差异;
降低血小板输注阈值或对早产儿更有利;
延伸阅读

Randomized Trial of Platelet-Transfusion Thresholds in Neonates

新生儿血小板输注阈值的随机对照试验

01-17, Article, 10.1056/NEJMoa1807320more

Abstract:
BACKGROUND: Platelet transfusions are commonly used to prevent bleeding in preterm infants with thrombocytopenia. Data are lacking to provide guidance regarding thresholds for prophylactic platelet transfusions in preterm neonates with severe thrombocytopenia.
METHODS: In this multicenter trial, we randomly assigned infants born at less than 34 weeks of gestation in whom severe thrombocytopenia developed to receive a platelet transfusion at platelet-count thresholds of 50,000 per cubic millimeter (high-threshold group) or 25,000 per cubic millimeter (low-threshold group). Bleeding was documented prospectively with the use of a validated bleeding-assessment tool. The primary outcome was death or new major bleeding within 28 days after randomization.
RESULTS: A total of 660 infants (median birth weight, 740 g; and median gestational age, 26.6 weeks) underwent randomization. In the high-threshold group, 90% of the infants (296 of 328 infants) received at least one platelet transfusion, as compared with 53% (177 of 331 infants) in the low-threshold group. A new major bleeding episode or death occurred in 26% of the infants (85 of 324) in the high-threshold group and in 19% (61 of 329) in the low-threshold group (odds ratio, 1.57; 95% confidence interval [CI], 1.06 to 2.32; P=0.02). There was no significant difference between the groups with respect to rates of serious adverse events (25% in the high-threshold group and 22% in the low-threshold group; odds ratio, 1.14; 95% CI, 0.78 to 1.67).
CONCLUSIONS: Among preterm infants with severe thrombocytopenia, those randomly assigned to receive platelet transfusions at a platelet-count threshold of 50,000 per cubic millimeter had a significantly higher rate of death or major bleeding within 28 days after randomization than those who received platelet transfusions at a platelet-count threshold of 25,000 per cubic millimeter. (Funded by the National Health Service Blood and Transplant Research and Development Committee and others; Current Controlled Trials number, ISRCTN87736839 .).

First Authors:
Anna Curley

Correspondence Authors:
Anna Curley

All Authors:
Anna Curley,Simon J Stanworth,Karen Willoughby,Susanna F Fustolo-Gunnink,Vidheya Venkatesh,Cara Hudson,Alison Deary,Renate Hodge,Valerie Hopkins,Beatriz Lopez Santamaria,Ana Mora,Charlotte Llewelyn,Angela D'Amore,Rizwan Khan,Wes Onland,Enrico Lopriore,Karin Fijnvandraat,Helen New,Paul Clarke,Timothy Watts