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Brain Inj. 2018;32(3):325-330. doi: 10.1080/02699052.2018.1425804. Epub 2018 Jan 17.

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

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a Center for Trauma and Critical Care, Department of Surgery , George Washington University , Washington , DC, USA.
b Department of Surgery , East Carolina University Brody School of Medicine , Greenville , NC.
c Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Departments of Surgery, Neurosurgery, and Hearing and Speech Sciences, Section of Surgical Sciences , Vanderbilt Brain Institute, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center; Surgical Service, General Surgery Section, Nashville VA, Medical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs , Nashville , TN.
d Department of Surgery , San Antonio Military Medical Center , Fort Sam Houston , TX.
e Department of Surgery , Carle Foundation Hospital , Urbana , IL.
f Department of Surgery , University of North Carolina At Chapel Hill , Chapel Hill , NC.
g Department of Surgery , Medical Center at Plano , Plano , TX.
h Department of Surgery , Medical Center of The Rockies , Loveland , CO.



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.


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.


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.


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


Traumatic brain injury; brain injury; closed head injury

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