Effects of platelet dysfunction and platelet transfusion on outcomes in traumatic brain injury patients

ABSTRACT

Objective: Platelet inhibition in traumatic brain injury (TBI) may be due to injury or antiplatelet medication use pre-injury. This study aims to identify factors associated with increased platelet arachidonic acid (AA) and adenosine diphosphate (ADP) inhibition and determine if platelet transfusion reduces platelet dysfunction and affects outcome.

Methods: Prospective thromboelastography (TEG) assays were collected on adult patients with TBI with intracranial injuries detected by computed tomography (CT). Outcomes included in-hospital mortality, and CT lesion expansion.

Results: Of 153 patients, ADP inhibition was increased in moderate and severe TBI compared to mild TBI (p = 0.0011). P2Y12 inhibiting medications had increased ADP inhibition (p = 0.0077). Admission ADP inhibition was not associated with in-hospital mortality (p = 0.24) or CT lesion expansion (p = 0.94). Mean reduction of ADP inhibition from platelet transfusion (−15.1%) relative to no transfusion (+ 11.7%) was not statistically different (p = 0.0472).

Conclusions: Mild TBI results in less ADP inhibition compared to moderate and severe TBI, suggesting a dose response relationship between TBI severity and degree of platelet dysfunction. Further, study is warranted to determine efficacy and parameters for platelet transfusion in patients with TBI.

KEYWORDS:

• Coagulopathy
• platelet dysfunction
• thromboelastography
• TEG
• traumatic brain injury

Acknowledgments

Andrew R. Guillotte was funded through a Summer Medical Student Research Fellowship from University of Missouri School of Medicine Office of Research and Department of Surgery. Additional funding was from scholarship funds of the Division of Neurological Surgery of University of Missouri School of Medicine.

Conflicts of Interest

The authors declare no conflict of interest.

Additional information

Funding

Andrew R. Guillotte was funded through a Summer Medical Student Research Fellowship from University of Missouri School of Medicine Office of Research and Department of Surgery. Additional funding was from scholarship funds of the Division of Neurological Surgery of University of Missouri School of Medicine.

Notes on contributors

Andrew R. Guillotte

Andrew R. Guillotte is a third year medical student at University of Missouri School of Medicine interested in pursuing a career in neurological surgery.

Joseph P. Herbert

Joseph P. Herbert, MD, is a third year resident in neurological surgery at University of Missouri School of Medicine.

Richard Madsen

Richard Madsen, PhD, is Professor Emeritus in the department of Statistics of University of Missouri with research interests in biostatistics.

Richard D. Hammer

Richard D. Hammer, MD, is an Associate Professor of Clinical Pathology with a focus on hematopathology

N. Scott Litofsky

N. Scott Litofsky, MD is Professor and Chief of the Division of Neurological Surgery and the neurosurgical liaison to the Trauma Program at University of Missouri Hospital and Clinics