Reversal of antiplatelet therapy in traumatic intracranial hemorrhage: Does timing matter?

Title

Reversal of antiplatelet therapy in traumatic intracranial hemorrhage: Does timing matter?

Creator

Pandya Urmil; Malik Alexander; Messina Michael; Albeiruti Abdul-Rahman; Spalding Chance

Publisher

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

Date

2018
2018-04

Description

Reversal of antiplatelet therapy with platelet transfusion in traumatic intracranial hemorrhage remains controversial. Several studies have examined this topic but few have investigated whether the timing of transfusion affects outcomes. Patients admitted to a level 1 trauma center from 1/1/14 to 3/31/16 with traumatic intracranial hemorrhage taking pre-injury antiplatelet therapy were retrospectively analyzed. Patients on concurrent pre-injury anticoagulant therapy were excluded. Per institutional guideline, patients on pre-injury clopidogrel received 2 doses of platelets while patients on pre-injury aspirin received 1 dose of platelets. Patients with worsening hemorrhage defined by an increase in the Rotterdam score on follow up CT were compared to those without worsening. Mortality, need for neurosurgical intervention, and timing of platelet transfusion were analyzed. A total of 243 patients were included with 23 (9.5%) having worsening hemorrhage. Patients with worsening hematoma had higher injury severity score, head abbreviated injury scale, incidence of subdural hematoma, mortality, and lower Glasgow coma scale. There was no significant difference in the number of minutes to platelet transfusion between groups. After logistic regression analysis the presence of subdural hematoma and lower admission Glasgow coma scale were predictors of worsening hematoma, while there remained no significant difference in minutes to platelet transfusion. The timing of platelet transfusion did not have any impact on rates of worsening hematoma for patients with traumatic intracranial hemorrhage on pre-injury antiplatelet therapy. Potential risk factors for worsening hematoma in this group are the presence of subdural hematoma and lower admission Glasgow coma scale.

Subject

*Platelet Aggregation Inhibitors; Adult; Aged; Antiplatelet therapy; Aspirin/therapeutic use; Clopidogrel; Female; Glasgow Coma Scale; Hematoma; Humans; Intracranial hemorrhage; Intracranial Hemorrhage; Middle Aged; Platelet transfusion; Platelet Transfusion/*methods; Retrospective Studies; Risk Factors; Subdural/etiology/*prevention & control; Ticlopidine/analogs & derivatives/therapeutic use; Time Factors; Traumatic brain injury; Traumatic/complications/*therapy

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Pages

88–92

Volume

50

Citation

Pandya Urmil; Malik Alexander; Messina Michael; Albeiruti Abdul-Rahman; Spalding Chance, “Reversal of antiplatelet therapy in traumatic intracranial hemorrhage: Does timing matter?,” NEOMED Bibliography Database, accessed May 16, 2021, https://neomed.omeka.net/items/show/3673.

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