E. Baughman1,2, J. G. Hein1, M. Jackson1,3, T. W. Wolff1,4, M. L. Moorman1,2, U. Pandya1,2, M. C. Spalding1,2 1OhioHealth Grant Medical Center,Division Of Trauma And Acute Care Surgery,Columbus, OH, USA 2Ohio University Heritage College of Osteopathic Medicine,Athens, OH, USA 3Northeast Ohio Medical University,Rootstown, OH, USA 4OhioHealth Doctors Hospital,Department of Surgery,Columbus, OH, USA
Introduction: Increases in vascular disease prevalence have led to as many as half of all US adults aged 45 to 75 being prescribed antiplatelet agents. Patients on antiplatelet medication with traumatic intracranial hemorrhages (tICH) have been shown to have a 3 to 15 times higher rate of mortality. Some institutions adopted the practice of giving platelet transfusions to patients with tICH on pre-injury antiplatelet therapy. Although intuitive, there is little matched cohort data to justify this practice and many studies are biased by disease burden. The aim of our study is to understand the efficacy of platelet transfusion for patients with tICH on pre-injury antiplatelet medication.
Methods: We identified patients on pre-injury antiplatelet medication admitted with a tICH to an urban, Level 1 trauma center between January 1, 2014 and June 30, 2018. Per institutional guidelines, patients admitted prior to September 2017 were transfused platelets, and those admitted after were not. The primary outcome was mortality. Secondary outcomes were: need for neurosurgical intervention, Intensive care unit length of stay, need for increased level of care, and discharge destination. Demographics, prehospital medications, comorbidities, injury characteristics, and hospitalization events were also evaluated. Chi squared analyses and t tests were used to compare the two groups.
Results: When comparing the platelet transfusion group (449) versus no transfusion group (102), demographics, prehospital medications, comorbidities, injury characteristics, and hospitalization events were not significant, including age (73.13 vs. 75.74, p=0.062), injury severity score (16.21 vs. 15.35, p=0.339), head abbreviated injury scale (7.10 vs. 6.93, p=0.890), Glasgow coma scale (11.9 vs. 11.5, p=0.354) and length of stay (5.39 vs. 5.55, p=0.772). The primary outcome of mortality was nonsignificant (p=0.193), with a 10% and 6% mortality in the transfused and non-transfused groups respectively. Secondary outcomes of neurosurgical intervention (11.6% vs. 7.8%, p=0.300), Intensive care unit length of stay (1.33 vs. 1.46 days, p=0.698), need for increased level of care (6.68% vs. 9.80%, p=0.273), and discharge destination (p=0.662) were also nonsignificant for transfused versus non-transfused groups. Subgroup analysis of patients with subarachnoid hemorrhage (SAH), a specific type of tICH, did reveal a significant difference in mortality (6.25% vs. 0%, p=0.022) and discharge destination (p=0.035) between the transfused versus non-transfused group.
Conclusion: This early analysis indicates that platelet transfusion may have a significant effect on mortality for patients with a SAH on pre-injury antiplatelet medication. Analysis of all tICH data agrees with previous literature supporting no empiric transfusion of platelets for tICH patients on pre-injury antiplatelet medication. Further study to validate this finding and to assess the impact on hematoma expansion should be undertaken.