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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.

Author information

1
a Center for Trauma and Critical Care, Department of Surgery , George Washington University , Washington , DC, USA.
2
b Department of Surgery , East Carolina University Brody School of Medicine , Greenville , NC.
3
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.
4
d Department of Surgery , San Antonio Military Medical Center , Fort Sam Houston , TX.
5
e Department of Surgery , Carle Foundation Hospital , Urbana , IL.
6
f Department of Surgery , University of North Carolina At Chapel Hill , Chapel Hill , NC.
7
g Department of Surgery , Medical Center at Plano , Plano , TX.
8
h Department of Surgery , Medical Center of The Rockies , Loveland , CO.

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.

KEYWORDS:

Traumatic brain injury; brain injury; closed head injury

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