Emergency Medicine Pharmacist Rhode Island Hospital, Rhode Island, United States
Introduction: The utility of platelet infusions for the reversal of antiplatelet therapy in the setting of traumatic intracranial hemorrhage (tICH) remains unclear. Several observational studies have found no difference in outcomes but were limited by low numbers of patients treated with P2Y12 inhibitors. This study aims to evaluate the impact of platelet therapy for the reversal of antiplatelet agents, including P2Y12 inhibitors, in the setting of tICH.
Methods: This single-center retrospective cohort study included patients presenting to the Rhode Island Hospital Emergency Department (ED) with a tICH while on an antiplatelet agent between January 1, 2018 and June 30, 2022. Patients were identified using the institution’s Trauma Registry Database and divided into 2 cohorts based on whether they received platelets or not. Exclusion criteria were hospital transfer, death within 6 hours of arrival, absence of a 6-hour repeat brain CT scan, and baseline thrombocytopenia. The primary outcome was the proportion of patients who attained hemostasis as defined by a lack of bleed expansion on the repeat CT scan. Secondary outcomes included thrombotic rates, in-hospital mortality, hospital length of stay (LOS), ICU LOS, and neurosurgical intervention.
Results: A total of 277 patients were analyzed with 197 patients (71%) on aspirin monotherapy, 65 patients (24%) on dual antiplatelet therapy, and 15 patients (5%) on clopidogrel monotherapy. We observed no significant difference in hemostasis between patients that received platelets and those that did not [73.2% vs. 72.7%, respectively (p=1)]. There was no difference for in-hospital mortality [6.5% vs. 5.8% (p=0.99)], mean hospital LOS [9.05 days vs. 7.91 days (p=0.51)], mean ICU LOS [7.03 days vs. 7.90 days (p=0.65)] and thrombotic complications [2.9% vs. 3.6% (p=1)]. There was a significant difference in neurosurgical intervention required between the platelet group and no-platelet group [9.4% vs 2.9% (p=0.04)].
Conclusions: Our findings suggest that there is no benefit associated with platelet administration for the reversal of aspirin or the combination of aspirin and clopidogrel in the setting of tICH. Clinical judgment should be used to determine the possible risks and benefits of platelet therapy in this population.
