Does Platelet Administration Affect Mortality in Elderly Head-Injured Patients Taking Antiplatelet Medications?

Abstract

A significant portion of patients sustaining traumatic brain injury (TBI) take antiplatelet medications (aspirin or clopidogrel), which have been associated with increased morbidity and mortality. In an attempt to alleviate the risk of increased bleeding, platelet transfusion has become standard practice in some institutions. This study was designed to determine if platelet transfusion reduces mortality in patients with TBI on antiplatelet medications. Databases from two Level I trauma centers were reviewed. Patients with TBI 50 years of age or older with documented preinjury use of clopidogrel or aspirin were included in our cohort. Patients who received platelet transfusions were compared with those who did not to assess outcome differences between them. Demographics and other patient characteristics abstracted included Injury Severity Score, Glasgow Coma Scale, hospital length of stay, and warfarin use. Three hundred twenty-eight patients comprised the study group. Of these patients, 166 received platelet transfusion and 162 patients did not. Patients who received platelets had a mortality rate of 17.5 per cent (29 of 166), whereas those who did not receive platelets had a mortality rate of 16.7 per cent (27 of 162) ( P = 0.85). Transfusion of platelets in patients with TBI using antiplatelet therapy did not reduce mortality.

Platelet transfusion: a systematic review of the clinical evidence

“…We identified 11 observational studies analyzing a total of 1300 patients with traumatic brain injury (TBI) or nontraumatic intracerebral hemorrhage . Two of the 11 studies were single‐arm studies addressing the role of PLTs among patients with TBI .…”

“…Nine studies compared PLT transfusion versus no PLT transfusion. Six studies included TBI patients receiving preinjury anti‐PLT medications; some of these patients had thrombocytopenia and others did not . Two studies included patients with nontraumatic intracerebral hemorrhage receiving preinjury anti‐PLT medications of whom some patients had thrombocytopenia and others did not .…”

Formation of Microparticles in the Injured Brain of Patients with Severe Isolated Traumatic Brain Injury

“…A large prospective randomized clinical study on 780 patients with hypertensive intracerebral haematoma demonstrated improved outcome in those who received intravenous infusion of stored platelets: postoperative haematoma volumes were smaller in the treated group and the mortality rate lower compared with controls (16% vs. 34%) [275]. There are four retrospective studies dealing with the effect of stored platelets in patients with TBI, treated with antiplatelet drugs prior to trauma [276][277][278][279]. These four studies have been summarized in a meta-analysis by Leong and David [280], overall showing no treatment benefits.…”

Management Dilemmas in Patients with Traumatic Brain Injury on Anticoagulants

“…CT scans performed before randomization and after 24 to 48 hours showed comparable mean total hemorrhage growth with versus without TXA (TXA group 5.9 ± 26.8 mL; placebo group, 8.1 ± 29.2 mL). A RCT (double-blind, placebo-controlled trial) by Yutthakasemsunt et al 16 enrolled 238 patients with moderate to severe TBI (GCS [4][5][6][7][8][9][10][11][12] and no coagulopathy, and found that no significant difference in ICH progression was observed between the TXA group and placebo patients (risk ratio [RR] = 0.65). The risk of death from all causes and the risk of an unfavorable outcome on the Glasgow outcome scale (GOS) were similar between groups (RR = 0.69 and Traumatic Brain Injury On Anticoagulants Dwarakanath, Deora • TBI without bleeding does not require pharmacotherapy for anticoagulation reversal.…”