High prevalence of pharmacologically induced platelet dysfunction in the acute setting of brain injury

Prinz, Vincent; Finger, Tobias; Bayerl, Simon; Rosenthal, Christoph; Wolf, Stefan; Liman, Thomas; Vajkoczy, Peter

doi:10.1007/s00701-015-2645-8

Cited by 16 publications

(15 citation statements)

References 28 publications

(38 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This latter effect has been considered to be mediated by nuclear factor kappa B (NF-κB) [264]. Although there is a potential risk of bleeding complications in a TBI situation when using ASA [265], the results of two studies showed no hazardous effects of ASA intake prior to injury [266,267].…”

Section: Acetylsalicylic Acid (Asa)mentioning

confidence: 99%

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

Nekludov

Mobarrez²,

Gryth³

et al. 2014

Journal of Neurotrauma

View full text Add to dashboard Cite

The potential pathophysiological role of circulating microparticles (MPs) has been recognized in various conditions, such as cardiovascular and thrombotic diseases. Traumatic brain injury (TBI) has a complex pathophysiology that involves coagulopathy and inflammation. We investigated endothelial-, platelet-, and leukocyte-derived microparticles (EMPs, PMPs, and LMPs, respectively) in 16 patients with severe isolated TBI. Arterial and cerebrovenous samples were taken repeatedly, during 1-72 h after injury. Subpopulations of MPs, exposing tissue factor (TF) and P-selection, were also studied. MP counts in cerebrovenous samples, irrespective of cellular origin, were higher in TBI cases, compared to healthy controls (peak levels of EMPs were approximately 7 times higher, PMPs 1.4 times higher, and LMPs 2 times higher, respectively; p<0.001 for all). MP counts declined sharply from high levels shortly after the trauma toward slightly elevated levels 72 h later. EMPs and PMPs exposing TF, as well as PMPs exposing P-selection, showed a transcranial gradient with higher concentration in cerebrovenous, compared to arterial, samples. In contrast, LMPs exposing TF were higher in arterial samples, suggesting accumulation of LMPs in the brain. We conclude that the pattern of circulating MPs is altered after TBI. PMPs exposing P-selection and EMPs exposing TF seem to be generated in the injured brain, whereas LMPs exposing TF are accumulated. The pathophysiological significance of these changes in MP pattern in TBI should be further investigated. Including MPs exposing brain-specific antigens in the assessment of brain injury would give further information of origin and likely give additional information of the size of the injury, given that the MP phenotypes investigated in the present study are not brain-specific markers.

show abstract

Section: Acetylsalicylic Acid (Asa)mentioning

confidence: 99%

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

Nekludov

Mobarrez²,

Gryth³

et al. 2014

Journal of Neurotrauma

View full text Add to dashboard Cite

show abstract

“…The results are expressed in the PRU (platelet reactivity unit) units showing the degree of aggregation mediated by P2Y12 receptors. [11,12,13] Acetylsalicylic acid irreversibly inhibits the COX-1 enzyme, then the synthesis of cyclic endoperoxides and all prostaglandins that result therefrom. The COX-1 inhibition inhibits the synthesis of thromboxane, and then prostacyclin and prostaglandin E2.…”

Section: Discussionmentioning

confidence: 99%

Puncture site bleeding complications in patients with Clopidogrel hyper-response

Žarko¹,

Ivan²,

Branisalva³

et al. 2020

roneuro

View full text Add to dashboard Cite

Dual antiplatelet therapy (clopidogrel and acetylsalicylic acid) is a standard for the embolization of planned intracranial aneurysms with CNS stent due to the possibility of stent thrombus formation. All anti-aggregation drugs, including those listed, have bleeding as a side effect. Three patients with aneurysm had an elevated response to antiplatelet therapy with clopidogrel, which was confirmed by a multiplate test on the "VerifyNow" system. After reducing the dose of clopidogrel or after interrupting it, with the introduction of low molecular weight heparin for the duration of five days, aneurysms were successfully resolved by intracranial implantation of the stent. Perioperative angiograms and postoperative CT angiograms have verified hematomas at the place of punction of the femoral artery. Bleeding was resolved by the femoral artery suture by a vascular surgeon. All patients were discharged home without further complications and with dual antiplatelet therapy. By measuring the platelet function in vitro, the degree of inhibition of platelet activity achieved by the action of the drug can be assessed. A specific test can identify those patients who are highly responsive to the drug with increased platelet reactivity and the possibility of increased risk of bleeding. Our suggestion is to reduce the dosage of clopidogrel or to leave it out for 24 hours with preventive doses of low molecular weight heparin or to change the strategy of treatment of intracranial aneurysm, i.e. avoiding implantation of CNS stent.

show abstract

“…The Multiplate analyzer was also used by Prinz et al in 103 neurosurgical patients with various types of acute brain injury (TBI, ICH, and SAH). 46 Impaired platelet function was found in more than 50% of patients with unknown preinjury medication intake and this underscores the value of POC testing in patients unable to give adequate information regarding medication intake. This finding was also observed by Bachelani et al who used the VerifyNow test in 84 patients with TBI.…”

Section: Antiplatelet Agent Activitymentioning

confidence: 99%

Point-of-Care Testing in Neurosurgery

Beynon

Wessels

Unterberg

2017

Semin Thromb Hemost

View full text Add to dashboard Cite

Coagulation disorders can have a major impact on the outcome of neurosurgical patients. The central nervous system is located within the closed space of the skull, and therefore, intracranial hemorrhage can lead to intracranial hypertension. Acute brain injury has been associated with alterations of various hemostatic parameters. Point-of-care (POC) techniques such as rotational thromboelastometry are able to identify markers of coagulopathy which are not reflected by standard assessment of hemostasis (e.g., hyperfibrinolysis). In patients with acute brain injury, POC test results have been associated with important outcome parameters such as mortality and need for neurosurgical intervention. POC devices have also been used to rapidly identify and quantify the effects of antithrombotic medication. In cases of life-threatening intracranial hemorrhage, this information can be valuable when deciding over administration of prohemostatic substances or immediate neurosurgical intervention. In elective neurosurgical procedures, POC devices can provide important information when unexpected bleeding occurs or in cases of prolonged operative time with subsequent blood loss. Initial experiences with POC devices in neurosurgical care have shown promising results but further studies are needed to characterize their full potential and limitations.

show abstract

High prevalence of pharmacologically induced platelet dysfunction in the acute setting of brain injury

Abstract: Our results demonstrate the high frequency of pharmacologically impaired platelet function in patients with unknown preexisting medication. Early assessment of platelet function is an important tool to allow optimized treatment in these patients.

Cited by 16 publications

References 28 publications

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

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

Puncture site bleeding complications in patients with Clopidogrel hyper-response

Point-of-Care Testing in Neurosurgery

Contact Info

Product

Resources

About