Antiplatelet Agent Reversal Is Unnecessary in Blunt Traumatic Brain Injury Patients Not Requiring Immediate Craniotomy
| Autor: | Joseph A Ibrahim, Indermeet S Bhullar, Michael L. Cheatham, Monica Jordan, Jocelyn E Hunter, Timothy R Smith, Karen Safcsak, Kojo Agyabeng-Dadzie |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Adolescent Traumatic brain injury medicine.medical_treatment Platelet Transfusion Wounds Nonpenetrating Young Adult Blunt Brain Injuries Traumatic medicine Cerebral Hemorrhage Traumatic Humans Craniotomy Aged Retrospective Studies Intracerebral hemorrhage business.industry Incidence General Medicine Middle Aged medicine.disease Survival Rate Platelet transfusion Coagulation Anesthesia Female business Platelet Aggregation Inhibitors |
| Zdroj: | The American surgeon. 86(7) |
| ISSN: | 1555-9823 |
| Popis: | Background The need to reverse the coagulation impairment caused by chronic antiplatelet agents in traumatic brain injury (TBI) patients with acute traumatic intracerebral hemorrhage (TICH) remains controversial. We sought to determine whether emergent platelet transfusion reduces the incidence of hemorrhage expansion, mortality, or need for neurosurgical intervention such as intracranial pressure (ICP) monitoring, burr holes, or craniotomy. Methods All adult blunt TICH patients (age ≥16 years) over a 4-year period were retrospectively reviewed. Patients with penetrating TBI, blunt TBI without TICH on admission computed tomography (CT), receiving warfarin, not on antiplatelet agents, or requiring immediate operative intervention were excluded. Patients were divided into 2 groups depending on whether they received a platelet transfusion: reversal group (RV) versus no reversal group (NR). Patient outcomes were analyzed using Mann-Whitney U and Fisher’s exact tests. Results 169 blunt TBI patients on chronic antiplatelet therapy were studied (102 RV group, 67 NR group). The groups were well matched with regard to age, Injury Severity Score, Abbreviated Injury Scale-head, Glasgow Coma Score, mechanism of injury, need for intubation, time to initial CT scan, and hospital length of stay. Immediate platelet transfusion did not alter the occurrence of TICH extension on follow-up CT (26% vs 21%, P = .71), TBI-specific mortality (9% vs 13%, P = .45), need for ICP monitor (2% vs 3%, P = 1.0), burr hole (1% vs 3%, P = .56), or craniotomy (1% vs 3%, P = .56). Discussion Immediate platelet transfusion is unnecessary in blunt TBI patients on chronic antiplatelet therapy who do not require immediate craniotomy. |
| Databáze: | OpenAIRE |
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