背景:尽管常规血小板功能检测的使用存在很大争议,VerifyNow血小板反应性单位(PRU)检测越来越多地被用作评估神经血管内手术术后血栓栓塞并发症风险的护理标准.
目的:我们进行了系统评价和荟萃分析,以检查血小板反应与神经血管内手术缺血事件风险之间的关系。评估即时血小板功能检测在预测血栓栓塞结局中的功效,并评估是否可以定义临床上有用的血小板反应阈值以标准化指南。
方法:PubMed,Embase,Scopus被搜查了.重复数据删除后,文章首先通过标题和摘要筛选相关性,其次是全文。
结果:在735篇文章中,纳入了22项研究,包括3266例接受神经血管内介入治疗的患者。诊断包括颅内和颅外病理,其中45.8%采用分流处理,支架辅助线圈栓塞的16.4%,15.8%颅内支架置入术,12.0%,简单的线圈栓塞,3.4%采用球囊辅助线圈栓塞,3.6%颅外支架置入术,和3.0%的替代方法。54.5%(12/22)的研究确定血小板低反应是术后血栓栓塞并发症的独立预测因子,27.3%(6/22)的研究报告了类似的情况,但无统计学意义的趋势。18.2%(4/22)的研究发现血小板反应与术后血栓栓塞并发症无相关性。PRU预防血栓栓塞并发症的估计临床阈值在研究中差异很大(范围:>144-295PRU)。Meta分析发现,与正常反应者相比,血小板低反应者发生血栓栓塞并发症的风险增加了2.23倍(RR=2.23,P=0.03)。
结论:虽然PRU对神经血管内手术的术后血栓栓塞并发症具有显著的预测价值,减少缺血事件的目标治疗阈值仍不清楚.进一步研究,例如现有数据的大型多中心队列,需要规范准则。
BACKGROUND: Despite the heavily debated use of routine platelet-function testing, the VerifyNow Platelet Reactivity Unit (PRU) assay has been increasingly adopted as standard of care for assessing risk of postoperative thromboembolic complications of
neuroendovascular surgery.
OBJECTIVE: We conducted a systematic review and meta-analysis to examine the relationship between platelet response and risk of ischemic events from
neuroendovascular surgery, assess the efficacy of point-of-care platelet-function testing in predicting thromboembolic outcomes, and assess whether a clinically useful threshold for platelet response can be defined in order to standardize guidelines.
METHODS: PubMed, Embase, and Scopus were searched. Following deduplication, articles were first screened for relevance by title and abstract, followed by full text.
RESULTS: Of 735 resultant articles, 22 studies consisting of 3266 patients undergoing
neuroendovascular intervention were included. Diagnoses included both intracranial and extracranial pathologies, of which 45.8% were treated with flow diversion, 16.4% with stent-assisted coil embolization, 15.8% with intracranial stenting, 12.0% with simple coil embolization, 3.4% with balloon-assisted coil embolization, 3.6% with extracranial stenting, and 3.0% with an alternate method. 54.5% (12/22) of studies determined platelet hyporesponse to be an independent predictor of postoperative thromboembolic complications, with 27.3% (6/22) of studies reporting a similar, but non-statistically significant trend. 18.2% (4/22) of studies found no relationship between platelet response and postoperative thromboembolic complications. The estimated clinical threshold for PRU to prevent thromboembolic complications varied greatly across studies (Range: > 144-295 PRU). Meta-analysis found platelet hyporesponse to have a 2.23-fold increased risk of thromboembolic complications compared to normoresponders (RR = 2.23, P = 0.03).
CONCLUSIONS: While PRU demonstrates a significant predictive value for postoperative thromboembolic complications of
neuroendovascular surgery, the target therapeutic threshold for minimizing ischemic events remains unclear. Further studies, such as large multicenter cohorts of the existing data, are needed to standardize guidelines.