Antiplatelet Reversal Is Not Associated With Decreased Progression of Intracranial Hemorrhage in Near-Isolated Traumatic Brain Injury: A Retrospective Clustered Analysis From Two Trauma Centers.

Autor: Dunne JR; Department of Trauma and Surgical Critical Care, Memorial Health University Medical, Savannah, Georgia., Hunt DL; Department of Surgery, TriStar Skyline Medical Center, Nashville, Tennessee., Chen CC; Department of Surgery, TriStar Skyline Medical Center, Nashville, Tennessee., Jacobs J; Center for Trauma and Acute Care Surgery Research, Clinical Services Group, HCA Healthcare, Nashville, Tennessee., Garland JM; Center for Trauma and Acute Care Surgery Research, Clinical Services Group, HCA Healthcare, Nashville, Tennessee., Harbour LF; Center for Trauma and Acute Care Surgery Research, Clinical Services Group, HCA Healthcare, Nashville, Tennessee., McBride K; Department of Trauma and Surgical Critical Care, Memorial Health University Medical, Savannah, Georgia., Fakhry SM; Center for Trauma and Acute Care Surgery Research, Clinical Services Group, HCA Healthcare, Nashville, Tennessee. Electronic address: Samir.Fakhry@HCAhealthcare.com.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2024 Oct; Vol. 302, pp. 501-508. Date of Electronic Publication: 2024 Aug 22.
DOI: 10.1016/j.jss.2024.07.100
Abstrakt: Introduction: Antiplatelet agents (AAs) may increase the risk of intracranial hemorrhage (ICH). It is unclear whether reversal of antiplatelet effects (REV = desmopressin acetate [DDAVP] + Platelets) decreases ICH progression. The goal of the study was to determine whether REV was associated with decreased progression of ICH on repeat brain computed tomography (CT) scan.
Methods: This is a clustered study (November 2019 to March 2022) at two regionally distinct trauma centers (TCs) with differing standards of practice in patients with ICH, one reversal with DDAVP + Platelets (REV+) and the other no reversal with DDAVP + Platelets (REV-). Using electronic and manual chart review, data were collected on inpatients aged ≥ 18 y on preinjury AAs with CT proven ICH (abbreviated injury scale head ≥ 2) and no other abbreviated injury scale > 2 injuries, who had at least one repeat CT scan within 120 h of admission. ICH progression on repeat brain CT scan, mortality, and resource utilization were compared via univariate analysis (α = 0.05).
Results: One hundred fourteen patients were enrolled: 72 REV+ at the first TC and 42 REV- at the second TC. REV+ group had fewer White patients and a lower proportion on preinjury aspirin but were otherwise similar. ICH progression rate was 24/72 (33.3%) for REV+ and 11/42 (26.2%) for REV- (P = 0.43). Isolated subarachnoid hemorrhage was the most common lesion, followed by isolated subdural hemorrhage. No patients required cranial surgery. All-cause mortality (expired + hospice) was 5/72 (6.9%) and 1/42 (2.4%), respectively (P = 0.29).
Conclusions: In this study of patients on preinjury AAs, REV was not associated with decreased ICH progression, lower mortality, or less resource utilization. These findings should be confirmed in a larger, prospective study.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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