Reversal of antiplatelet therapy in traumatic intracranial hemorrhage: Does timing matter?
| Autor: | Urmil Pandya, Alexander Malik, Abdul-Rahman Albeiruti, Chance Spalding, Michael Messina |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Ticlopidine Time Factors Traumatic brain injury Platelet Transfusion 03 medical and health sciences 0302 clinical medicine Hematoma Risk Factors Physiology (medical) medicine Humans Glasgow Coma Scale cardiovascular diseases Aged Retrospective Studies Abbreviated Injury Scale Aspirin business.industry 030208 emergency & critical care medicine General Medicine Middle Aged medicine.disease Intracranial Hemorrhage Traumatic Clopidogrel Platelet transfusion Hematoma Subdural Neurology Anesthesia Platelet aggregation inhibitor Injury Severity Score Surgery Female Neurology (clinical) business 030217 neurology & neurosurgery Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 50 |
| ISSN: | 1532-2653 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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