A.M. Jose1, B. Zangbar1, A. Rafieezadeh1, K. Prabhakaran1, G. Froula1, J. Klein1, I. Shnaydman1, M. Bronstein1, J.M. Kirsch1 1New York Medical College, Surgery, Valhalla, NY, USA
Introduction: The role of platelet transfusion for patients with traumatic brain injury(TBI) on antiplatelet medications is a topic of great debate. While prior studies have shown that incompatible platelet transfusions are associated with worse outcomes in non-traumatic intracranial hemorrhage, the impact of platelet compatibility in the context of TBI has not been thoroughly investigated. We aim to determine outcomes of TBI patients who received platelet transfusion for antiplatelet medication reversal based on compatibility status.
Methods: A retrospective cohort analysis on TBI patients on antiplatelet medication admitted to a level I trauma center(2021-2023). Patients were categorized based on ABO-compatibility of the transfused platelets: compatible(CG) and incompatible group(IG). IG only includes major ABO incompatibility. The primary outcome was mortality. Secondary outcomes included discharge GCS, progression of intracranial hemorrhage/new bleed on CT, platelet count change at 24 hours post-transfusion, and hospital length of stay (LOS).
Results:127 patients(mean age: 77.47±10.25 years, male:60.6%) were analyzed among in whom aspirin use was documented in 90.6% and P2Y12 inhibitors in 28.3%. 73.2% received ABO-compatible platelets and 26.8% received ABO-incompatible platelets. There was a median platelet increase in the CG and decrease in the IG (4500vs. -10000)(p=0.023) 24 hours post-transfusion. No significant differences were found between the CG and IG in terms of mortality(21.5%vs.20.6%), progression of intracranial hemorrhage/ new bleed(32.3%vs.29.4%), and discharge GCS(15vs.15), and hospital LOS (7 vs. 7) (p>0.05for all). There were no significant differences in the rates of in-hospital complications including venous thromboembolism, unplanned admission to ICU/OR, and unplanned intubation (p>0.05 for all). After adjusting for age, sex, race, ISS, GCS and compatibility status, the multivariate regression demonstrated that incompatible transfusion was not an independent determinant of mortality (p=0.513).
Conclusion:ABO-compatible transfusions resulted in a median increase in platelet count and a decrease with incompatible transfusion. ABO compatibility does not significantly impact mortality in TBI patients for antiplatelet reversal. Further research is necessary to develop evidence-based guidelines for platelet transfusion practices in this population.