Goal-directed platelet transfusions correct platelet dysfunction and may improve survival in patients with severe traumatic brain injury

Furay, Elisa; Daley, Mitch; Teixeira, Pedro G.; Coopwood, Thomas B.; Aydelotte, Jayson; Malesa, Natalia; Tellinghuisen, Christian; Ali, Sádia; Brown, Lawrence H.; Brown, Carlos V R

doi:10.1097/ta.0000000000002047

Cited by 35 publications

(34 citation statements)

References 31 publications

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“…Highlighting this, studies of platelet function-targeted therapy have failed to demonstrate clinical efficacy. While there is some evidence that platelet transfusion can correct platelet dysfunction in TBI [ 60 ], others studies suggest that transfusions are more likely to improve aspirin-induced, rather than trauma-induced, dysfunction [ 24 ]. Desmopressin could be an alternative to platelet transfusions, though there exist only mixed results from low-quality studies [ 61 , 62 ].…”

Section: Discussionmentioning

confidence: 99%

Time Course of Hemostatic Disruptions After Traumatic Brain Injury: A Systematic Review of the Literature

et al. 2020

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Almost two-thirds of patients with severe traumatic brain injury (TBI) develop some form of hemostatic disturbance, which contributes to poor outcome. While the initial head injury often leads to impaired clot formation, TBI is also associated with an increased risk of thrombosis. Most likely there is a progression from early bleeding to a later prothrombotic state. In this paper, we systematically review the literature on the time course of hemostatic disruptions following TBI. A MEDLINE search was performed for TBI studies reporting the trajectory of hemostatic assays over time. The search yielded 5,049 articles, of which 4,910 were excluded following duplicate removal as well as title and abstract review. Full-text assessment of the remaining articles yielded 33 studies that were included in the final review. We found that the first hours after TBI are characterized by coagulation cascade dysfunction and hyperfibrinolysis, both of which likely contribute to lesion progression. This is then followed by platelet dysfunction and decreased platelet count, the clinical implication of which remains unclear. Later, a poorly defined prothrombotic state emerges, partly due to fibrinolysis shutdown and hyperactive platelets. In the clinical setting, early administration of the antifibrinolytic agent tranexamic acid has proved effective in reducing head-injury-related mortality in a subgroup of TBI patients. Further studies evaluating the time course of hemostatic disruptions after TBI are warranted in order to identify windows of opportunity for potential treatment options.

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Section: Discussionmentioning

confidence: 99%

Time Course of Hemostatic Disruptions After Traumatic Brain Injury: A Systematic Review of the Literature

et al. 2020

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“…Early ( < 12 hours from symptom onset) platelet transfusion improved platelet activity assay results and was associated with smaller final hemorrhage size and more independence at 3 months (modified Rankin Score < 4) [63]. Similarly, in a TBI population, TEG-directed platelet transfusion was associated with a decreased mortality compared to a historical cohort in a retrospective study by Furay et al [64].…”

Section: Antiplatelet Therapymentioning

confidence: 91%

Assessment and management of coagulopathy in neurocritical care

et al. 2019

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Normal coagulation is a balance between hemostatic and fibrinolytic processes, the loss of which may result in either excessive bleeding or intravascular thrombosis, which defines coagulopathy. Abnormalities in coagulation testing may also be considered evidence of coagulopathy, even in the absence of clinical sequelae of bleeding or thrombosis. There is limited data on the incidence of coagulopathy in neurocritical care units; however, it is commonly seen in critically ill patients with incidences ranging widely from 14% to 81% [1,2]. Coagulopathies may be acquired through a variety of conditions including trauma, organ failure and the use of medications, and may

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“…There are many advantages in using VETs to detect CTBI [4,6,23,48,58]. For example, VETs provide real-time coagulation information on the presence of anticoagulation or antiplatelet medications and the patient's initial coagulation profile, allowing for the monitoring of therapeutic interventions such as hemostatic adjuncts or blood component transfusion [23,47,[58][59][60][61][62][63]. Furthermore, modified TEG ® Platelet Mapping (TEG-PM ® ) and ROTEM ® with adjunctive multiple electrode aggregometry (MEA) can also be used to quickly determine platelet function abnormalities from inherent TBI coagulopathy or antiplatelet medications [23,39,58,[61][62][63][64][65][66][67].…”

Section: Implications Of Ctbi and Relation To Vet-based Definitionmentioning

confidence: 99%

Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury

Bradbury

Thomas

Sorg

et al. 2021

JCM

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A unique coagulopathy often manifests following traumatic brain injury, leading the clinician down a difficult decision path on appropriate prophylaxis and therapy. Conventional coagulation assays—such as prothrombin time, partial thromboplastin time, and international normalized ratio—have historically been utilized to assess hemostasis and guide treatment following traumatic brain injury. However, these plasma-based assays alone often lack the sensitivity to diagnose and adequately treat coagulopathy associated with traumatic brain injury. Here, we review the whole blood coagulation assays termed viscoelastic tests and their use in traumatic brain injury. Modified viscoelastic tests with platelet function assays have helped elucidate the underlying pathophysiology and guide clinical decisions in a goal-directed fashion. Platelet dysfunction appears to underlie most coagulopathies in this patient population, particularly at the adenosine diphosphate and/or arachidonic acid receptors. Future research will focus not only on the utility of viscoelastic tests in diagnosing coagulopathy in traumatic brain injury, but also on better defining the use of these tests as evidence-based and/or precision-based tools to improve patient outcomes.

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Goal-directed platelet transfusions correct platelet dysfunction and may improve survival in patients with severe traumatic brain injury

Abstract: Therapeutic, level II.

Cited by 35 publications

References 31 publications

Time Course of Hemostatic Disruptions After Traumatic Brain Injury: A Systematic Review of the Literature

Time Course of Hemostatic Disruptions After Traumatic Brain Injury: A Systematic Review of the Literature

Assessment and management of coagulopathy in neurocritical care

Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury

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