Platelet transfusion does not improve outcomes in patients with brain injury on antiplatelet therapy

ABSTRACT

Introduction: Platelet dysfunction following traumatic brain injury (TBI) is associated with worse outcomes. The efficacy of platelet transfusion to reverse antiplatelet medication (APM) remains unknown. Thrombelastography platelet mapping (TEG-PM) assesses platelet function. We hypothesize that platelet transfusion can reverse the effects of APM but does not improve outcomes following TBI.

Methods: An observational study at six US trauma centres was performed. Adult patients on APM with CT evident TBI after blunt injury were enrolled. Demographics, brain CT and TEG-PM results before/after platelet transfusion, length of stay (LOS), and injury severity score (ISS) were abstracted.

Results: Sixty six patients were enrolled (89% aspirin, 50% clopidogrel, 23% dual APM) with 23 patients undergoing platelet transfusion. Transfused patients had significantly higher ISS and admission CT scores. Platelet transfusion significantly reduced platelet inhibition due to aspirin (76.0 ± 30.2% to 52.7 ± 31.5%, p < 0.01), but had a non-significant impact on clopidogrel-associated inhibition (p = 0.07). Platelet transfusion was associated with longer length of stay (7.8 vs. 3.5 days, p < 0.01), but there were no differences in mortality.

Conclusion: Platelet transfusion significantly decreases platelet inhibition due to aspirin but is not associated with change in outcomes in patients on APM following TBI.

KEYWORDS:

• Traumatic brain injury
• brain injury
• closed head injury

Declaration of Interest

Authors report no conflicts of interest. Dr. Sarani serves as an advisor to Haemonetics, Corps.

Additional information

Funding

Funding was provided by NCATS UL1TR000445 for REDCap (all authors), Vanderbilt Faculty Research Scholars Program (mbp); National Institutes of Health NHLBI R01HL111111 (mbp) and NIGMS R01GM120484(mbp).