F. S. Jehan1, M. Zeeshan1, A. Jain1, T. O’Keeffe1, N. Kulvatunyou1, A. Tang1, L. Gries1, E. Zakaria1, B. Joseph1 1University Of Arizona,Tucson, AZ, USA
Introduction:
A significant portion of patients sustaining traumatic brain injury (TBI) are on antiplatelet medications. The role of the cyclooxygenase inhibitor (Aspirin) is well studied; however, the reversal of P2Y12 inhibitors after intracranial hemorrhage remains unclear. The aim of our study is to evaluate outcomes after traumatic brain injury in patients who are on preinjury P2Y12 inhibitors.
Methods:
We analyzed our prospectively maintained traumatic brain injury database from 2014-2106 and included all patients with intracranial hemorrhage (ICH) who were on P2Y12 inhibitors (Clopidogrel, Prasugrel, Ticagrelor). Regression analysis was performed adjusting for the age, gender, race, admission Glasgow coma scale (GCS) score, transfusion of blood products, severity of injury, type and size of ICH. Outcome measures included progression of ICH, adverse discharge disposition (SNiF), and mortality.
Results:
A total 243 patients with ICH were on preinjury P2Y12 inhibitor met our inclusion criteria and were analyzed. Mean age was 55 + 18 years, 58% were males and 60% were white while the median [IQR] ISS was 14[9-22]. 74% received platelet transfusion after admission. The mean units of platelet transfusion were 1.6 + 2 units. On regression analysis after controlling for confounders, patients who received platelet transfusion had lower rate of progression of ICH on repeat head CT scan (OR: 0.77; 95%CI [0.4-0.8], p=0.01), and decreased rate of neurosurgical intervention (OR: 0.86; 95%CI [0.32-0.9], p=0.03) compared to those who did not. Overall mortality was 11%. In addition, patients on P2Y12 inhibitors who received platelet transfusion had lower odds of discharge to a skilled nursing facility SNiF (OR: 0.71; 95%CI [0.5-0.0.8], p=0.02) and mortality (OR: 0.85; 95%CI [0.44-0.91], p=0.02) as well compared to those patients who did not receive platelet transfusion.
Conclusion:
Platelet transfusion after traumatic ICH in patients on P2Y12 inhibitors is associated with decreased risk of progression and neurosurgical intervention after traumatic intracranial hemorrhage. In addition, patients with platelet transfusion had lower mortality and were less likely to be discharged to a SNiF. Further randomized studies are required to unify the practice of platelet transfusion after ICH in patients on P2Y12 inhibitors to improve outcomes.