A. Malik2, M. Messina3, U. Pandya1 1Grant Medical Center,Trauma Services,Columbus, OH, USA 2Northeastern Ohio Medical University,Rootstown, OH, USA 3Ohio University,Heritage College Of Medicine,Athens, OH, USA
Introduction: The utility of antiplatelet therapy reversal with platelet transfusion in patients with traumatic intracranial hemorrhage remains controversial. Several studies have examined this topic but few have investigated whether the timing of platelet transfusion has any effect on outcomes.
Methods: Medical records of all patients admitted to a level 1 trauma center from 1/1/14 to 3/31/16 with blunt traumatic intracranial hemorrhage who were 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. Time from hospital presentation to start of platelet transfusion was determined and patients were categorized as either receiving early transfusion (≤ 240 minutes) or late transfusion (> 240 minutes). Primary outcomes of interest included intracranial hematoma expansion and in-hospital mortality. Presence of hematoma expansion was determined by radiologic interpretation comparing initial and repeat head CT imaging. P-values < 0.05 were considered statistically significant. Multivariate regression analysis was used to control for potentially confounding variables.
Results:A total of 276 patients met inclusion criteria with 97 in the early transfusion group and 151 in the late transfusion group. There were no significant differences in age, head abbreviated injury scale, or gender between the groups. Patients in the early group had a significantly higher injury severity score (18.7 ± 8.79 versus 15.0 ± 7.90, p=0.0006) and significantly lower admission Glasgow coma scale (13.1 ± 3.83 versus 14.2 ± 2.57, p= 0.003). The early transfusion group had a higher rate of hematoma expansion (36.9% versus 18.8%) and a higher mortality (22.7% versus 5.3%). After multivariate regression analysis, however, there was no significant difference in hematoma expansion or mortality between the early and late transfusion groups.
Conclusion:After correcting for confounders, patients on pre injury antiplatelet therapy who received early platelet transfusion after traumatic intracranial hemorrhage did not have significantly different rates of mortality or hematoma expansion than patients who received later platelet transfusion. Early platelet transfusion may not be beneficial in this patient population.
