Platelet Transfusion Does Not Improve Outcomes in Brain Injured Patients on Antiplatelet Therapy_
P. Maluso1 , C.L. Reynolds3 , M. Patel4 , S. Holland5 , N. Gamsky1 , H. Moore2 , E. Acquista6 , M. Carrick7 , R.L. Amdur1 , H. Hancock5 , J. Dunn9 , B. Sarani1 ; 1George Washington University School Of Medicine And Health Sciences, Surgery, Washington, DC, USA; 2Carle Foundation Hospital, Surgery, Urbana, IL, USA; 3East Carolina University Brody School Of Medicine, Surgery, Greenville, NC, USA; 4Vanderbilt University Medical Center, Surgery, Nashville, TN, USA; 5San Antonio Military Medical Center, Surgery, Fort Sam Houston, TX, USA; 6University Of North Carolina At Chapel Hill, Surgery, Chapel Hill, NC, USA; 7Medical Center At Plano, Surgery, Plano, TX, USA; 8Columbia University College Of Physicians And Surgeons, Surgery, New York, NY, USA; 9Medical Center Of The Rockies, Surgery, Loveland, CO, USA_x000D_ Introduction: Brain injury is the most common cause of death following trauma. Platelet dysfunction is associated with worsening hemorrhage following brain injury (TBI). Use of antiplatelet medications (APM) is common, especially in elderly patients but the efficacy of platelet transfusion 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 clinical outcomes in TBI patients on APM.
Methods: A 2 year prospective, observational study at 6 US trauma centers was performed. Patients over 17 years old on APM with CT evident TBI after blunt injury were enrolled. Patients underwent TEG-PM and brain CT on arrival and repeat imaging within 24 hours. Platelets were transfused and repeat TEG-PM was ordered at physician discretion. Demographics, platelet transfusion, brain CT and TEG-PM results, length of stay (LOS), and injury severity score (AIS) were abstracted. Groups were compared using student t-test.
Results: 66 patients were enrolled (89% aspirin, 34% clopidogrel, 2% ticagrelor). 23 patients underwent platelet transfusion (table). The transfused group had significantly higher AIS and CT brain injury scores. TEG variables were not significantly associated with the decision to transfuse platelets(table 2). MA(AA) increased and %inhibition(AA) decreased significantly following transfusion but other parameters were unchanged. CT brain injury scores did not change after transfusion (mean change 0.10 ± 0.41, p=0.1). Among non-transfused patients with repeat CT scores available (n=29), the change in mean Marshall CT score was 0. Among transfused patients (n=23), mean CT score change before/after transfusion was 0.22 ± 0.60 (p=0.1). Transfusion was associated with longer LOS (7.8 v 3.5 days, p\u3c0.01), but this was not significant after controlling for AIS. There was no difference in mortality.
Conclusion:Platelet transfusion significantly decreases degree of platelet inhibition in the arachidonic acid pathway in TBI patients but is not associated with change in CT brain injury scores or clinical outcomes
