Avoiding Antiplatelet Reversal in Non-Operative Intracranial Hemorrhages: Functional Outcomes of Guideline-Based Practice

Introduction: Intracranial hemorrhage (ICH) is a common, life-threatening neurological pathology in aging patients, many of whom take antiplatelet medications with potential to worsen the hemorrhage. In the event of ICH, Thomas Jefferson University Hospital (TJUH) follows a protocol modeling the 2016 Neurocritical Care Society (NCS) joint guidelines for antiplatelet medication reversal. We analyzed pre- and post-NCS guideline data from TJUH for outcomes of non-operative ICH patients in order to tease out the potential benefits of this protocol. Methods: This retrospective cohort study took place from January 2016 – Jan. 2018 at a tertiary care center: TJUH. Patients included were ³18 y.o., on antiplatelet therapy who, had CTs available for evaluation of expansion, and did not undergo surgical management. The primary outcomes measured for comparison were both the admission and discharge Glasgow Coma Scores (GCS), admission and discharge modified Rankin Scores (mRS), time to death, hematoma expansion, and in-hospital mortality. T-tests, the Kolmogorov-Smirnov-test, and Chi-Square test for independence were used. Results: For pre- and post-protocol groups, no significant difference existed for GCS or mRS, at admission and discharge. There were no significant findings for in-hospital mortality and hemorrhage expansion. Discussion: TJUH established a protocol in line with the 2016 NCS joint guidelines for managing ICH in patients on antiplatelet therapies. This protocol recommends discontinuing antiplatelet therapy and not transfusing platelets in patients not receiving surgical management. We examined the protocol efficacy have found no significant differences in the pre- and post-protocol groups, indicating patient outcomes may be equivalent

Angiogram Negative Subarachnoid Hemorrhage: Incidence, Outcomes, and Predisposition

Introduction: Subarachnoid hemorrhage (SAH) is a medical emergency that may lead to deleterious outcomes unless the underlying cause is determined and managed promptly to prevent further rebleed. Though a significant percentage of cases of SAH have no identifiable pathology, there is a lack of data related to outcomes, predispositions, and whether there has been an increase in the incidence of angiogram negative SAH (anSAH). This study aimed to assess the current incidence of anSAH and factors that are associated with outcomes and predisposition among patients diagnosed with anSAH. Methods: A retrospective chart review was performed. Medical records of patients at Jefferson Hospital for Neuroscience who underwent cerebral angiography between 2010 and 2019 were reviewed to create a database from which patients diagnosed with anSAH were identified. Data related to clinical outcome, medical history, and demographics were collected. When data collection is complete, statistical analysis will be performed to evaluate the significance of the data. Results: Of 4914 patients in the database, 1038 patients were identified as likely having anSAH, though the results must be verified. The incidence of anSAH was 21.1%. Due to ongoing data collection, no interim analysis was possible to assess variables associated with outcomes and predisposition for anSAH. Discussion: As a result of incomplete data, the impact of the study on predicting outcomes and assessing predisposition for anSAH is unknown. However, the data suggest increased anSAH incidence in recent times, indicating that anSAH remains a significant subtype of SAH that clinicians should consider in the differential diagnosis