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Platelet Reactivity Testing for Aspirin Patients Who Sustain Traumatic Intracranial Hemorrhage

Published:March 04, 2021DOI:https://doi.org/10.1016/j.jss.2021.01.039

      Highlights

      • Decisions to transfuse head injured patients for patients with known or suspected home aspirin use can be guided by platelet reactivity testing to ascertain platelet function.
      • Seventy percent of patients with known or suspected home aspirin use were considered inhibited on the initial platelet reactivity test, and 88% of these patients had confirmation of home aspirin medication in the medical record.
      • Thirty percent of patients were spared platelet transfusion based on platelet reactivity test values that demonstrated a lack of platelet inhibition.

      Abstract

      Background

      Patients who take aspirin and sustain traumatic intracranial hemorrhage (tICH) are often transfused platelets in an effort to prevent bleeding progression. The efficacy of platelet transfusion is questionable, however, and some medical societies recommend that platelet reactivity testing (PRT) should guide transfusion decisions. The study hypothesis was that utilization of PRT to guide platelet transfusion for tICH patients suspected of taking aspirin would safely identify patients who did not require platelet transfusion.

      Methods

      This was a retrospective study of patients with blunt tICH who received PRT for known or suspected aspirin use between June 2014 and December 2017 at a level I trauma center. Chart abstraction was conducted to determine home aspirin status, and PRT values were used to classify patients as therapeutic or nontherapeutic on aspirin. Differences were assessed with Kruskal-Wallis and chi-square tests.

      Results

      157 patients met study inclusion criteria, and 118 (75%) patients had documented prior aspirin use. PRT results were available approximately 1.7 h (IQR: 0.9, 3.2) after arrival. Upon initial PRT, 70% of patients were considered inhibited and 88% of those patients had aspirin documented as a home medication. Conversely, 18% of patients with home aspirin use had normal platelet reactivity. Clinically significant worsening of the tICH did not significantly differ when comparing those who received platelet transfusion with those who did not (8% versus 7%, P = 0.87).

      Conclusions

      Platelet reactivity testing can detect platelet inhibition related to aspirin and should guide transfusion decisions for head injured patients in the initial hours after trauma.

      Keywords

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