Platelet transfusion does not improve outcomes in patients with brain injury on antiplatelet therapy.

Abstract

INTRODUCTION:

Platelet dysfunction following traumatic brain injury (TBI) is associated with worse outcomes. The efficacy of platelet transfusion to reverse antiplatelet medication (APM) remains unknown. Thrombelastography platelet mapping (TEG-PM) assesses platelet function. We hypothesize that platelet transfusion can reverse the effects of APM but does not improve outcomes following TBI.

METHODS:

An observational study at six US trauma centres was performed. Adult patients on APM with CT evident TBI after blunt injury were enrolled. Demographics, brain CT and TEG-PM results before/after platelet transfusion, length of stay (LOS), and injury severity score (ISS) were abstracted.

RESULTS:

Sixty six patients were enrolled (89% aspirin, 50% clopidogrel, 23% dual APM) with 23 patients undergoing platelet transfusion. Transfused patients had significantly higher ISS and admission CT scores. Platelet transfusion significantly reduced platelet inhibition due to aspirin (76.0 ± 30.2% to 52.7 ± 31.5%, p < 0.01), but had a non-significant impact on clopidogrel-associated inhibition (p = 0.07). Platelet transfusion was associated with longer length of stay (7.8 vs. 3.5 days, p < 0.01), but there were no differences in mortality.

CONCLUSION:

Platelet transfusion significantly decreases platelet inhibition due to aspirin but is not associated with change in outcomes in patients on APM following TBI.

• Authors: Jeremy L Holzmacher, Cassandra Reynolds, Mayur Patel, Patrick Maluso, Seth Holland, Nathaniel Gamsky, Henry Moore, Elizabeth Acquista, Matthew Carrick, Richard Amdur, Heather Hancock, Michael Metzler, Julie Dunn, Babak Sarani
• Journal: Brain injury (Brain Inj) Vol. 32 Issue 3 Pg. 325-330 ( 2018) ISSN: 1362-301X [Electronic] England
• PMID: 29341793 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Aspirin

Topics

• Aged
• Aged, 80 and over
• Aspirin (therapeutic use)
• Brain Injuries (therapy)
• Clopidogrel (therapeutic use)
• Female
• Humans
• Injury Severity Score
• Length of Stay
• Male
• Platelet Aggregation Inhibitors (therapeutic use)
• Platelet Transfusion (methods)
• Statistics, Nonparametric
• Treatment Outcome