Hemorrhagic Complications of External Ventriculostomy in the Aspirin and P2Y12 Response Assay Era

Majmundar, Neil; Sarris, Christina E.; Shastri, Darshan; Doran, Joseph; Gandhi, Chirag D.; Assina, Rachid

doi:10.1016/j.wneu.2018.10.181

Cited by 10 publications

(18 citation statements)

References 23 publications

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“…Among the included studies, four were single-arm studies examining neurosurgical patients who have undergone a POC PFT, whereas three were double-arm studies comparing the use of POC PFT and SCT. Three of the studies dealt with neurosurgical clipping and coiling for aneurysms [ 20 – 22 ], two involved decompressive craniotomies [ 23 , 24 ], and one involved external ventricular drain insertion [ 25 ]. One study involved a wide range of emergent neurosurgical procedures ranging from craniotomies to hematoma evacuation [ 26 ].…”

Section: Resultsmentioning

confidence: 99%

“…Beynon and team [ 26 ] used the Multiplate® Analyzer. Majmundar et al [ 25 ] used the VerifyNow® Assay. Baseline characteristics of the seven included studies are summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Six studies [ 20 , 21 , 23 – 26 ] reported the use of blood products, 2 [ 23 , 25 ] of which compared transfusion between two patient groups—a group that underwent POC PFT and another group that underwent SCT instead. Results are summarized in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

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Point-of-care platelet function testing for guided transfusion in neurosurgical management of intracranial hemorrhage: a systematic review

Lim

Sim

et al. 2022

Eur J Med Res

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Given the rising prevalence of antiplatelet therapy, rapid preoperative identification of patients with bleeding diathesis is necessary for the guidance of blood product administration. This is especially relevant in neurosurgery for intracranial hemorrhage (ICH), where indiscriminate transfusions may lead to further hemorrhagic or thromboembolic injury. Point-of-care (POC) testing of platelet function is a promising solution to this dilemma, as it has been proven effective in cardiac surgery. However, to date, POC platelet function testing in neurosurgery has not been extensively evaluated. This systematic review appraises the use of POC platelet function test (PFT) in emergency neurosurgery in terms of its impact on patient outcomes.A comprehensive search was conducted on four electronic databases (Pubmed, MEDLINE, Embase, and Cochrane) for relevant English language articles from their respective inceptions until 1 June 2022. We included all randomized controlled trials and cohort studies that met the following inclusion criteria: (i) involved adult patients undergoing neurosurgery for ICH; (ii) evaluated platelet function via POC PFT; (iii) reported a change in perioperative blood loss; and/or (iv) reported data on treatment-related adverse events and mortality. Assessment of study quality was conducted using the Newcastle Ottawa Quality Assessment Scale for Cohort Studies and Case–Control Studies, and the JBI Critical Appraisal Checklist for Case Series.The search yielded 2,835 studies, of which seven observational studies comprising 849 patients met the inclusion criteria for this review. Overall, there is evidence that the use of POC PFT to assess bleeding risk reduced bleeding events, thromboembolic adverse outcomes, and the length of hospitalization. However, there is currently insufficient evidence to suggest that using POC PFT improves blood product use, functional outcomes or mortality.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Point-of-care platelet function testing for guided transfusion in neurosurgical management of intracranial hemorrhage: a systematic review

Lim

Sim

et al. 2022

Eur J Med Res

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“…15,16 For those patients drained after administration of antiplatelet agents, platelet infusions are commonly used though this may not alter the rate of associated hemorrhage. 17 The potential benefits of aspirin at slightly more delayed time points following ventriculostomy and aneurysm securing procedures, particularly during the period most associated with delayed cerebral ischemia (DCI), 4 likely warrant further investigation. It has been suggested that a potential mechanism of action lies in a reduction in the rate of microthrombosis that may complicate subarachnoid hemorrhage and represent an additional pathophysiological process for DCI in addition to vasospasm.…”

Section: Discussionmentioning

confidence: 99%

Impact of Intravenous Aspirin Administration on Ventriculostomy-Associated Hemorrhage in Coiled Acute Subarachnoid Hemorrhage Patients

et al. 2021

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Purpose: Aspirin has beneficial effects on coiling, even in acute subarachnoid hemorrhage, but there is also a perceived risk of increased bleeding and, importantly, a concern regarding ventriculostomy-associated hemorrhage (VAH) in those with complicating hydrocephalus. We aimed to assess the rate and extent of VAH in patients specifically treated with procedural intravenous aspirin during endovascular coiling of ruptured intracranial aneurysms.Materials and Methods: This was a single neurovascular center retrospective observational study of consecutive patients treated over a three-year period. The rate of VAH assessed using computed tomography and clinical outcomes were compared in patients receiving intraprocedural intravenous aspirin loading (n=90) versus those that did not receive the drug (n=40).Results: There was a significantly elevated rate of VAH in patients receiving intravenous aspirin (30% vs. 2.5%, odds ratio 16.7 [95% confidence interval: 2.2–128.0], P<0.0001). The majority of VAH was <10 mm in size (70%) with the largest bleed measuring 20 mm. No hematoma required surgical evacuation. No difference in favorable outcome at discharge was demonstrated. There was no difference in mortality between the 2 groups.Conclusion: Loading with intravenous aspirin during endovascular treatment of ruptured intracranial aneurysms significantly increases the risk of VAH, but most are small with minimal impact on clinical outcome at discharge. Intravenous aspirin should probably be reserved for selected cases but should not be withheld based on risk of VAH.

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“…In contrast, Majmundar et al 25 (n = 345) reported that the use of VerifyNow® assay intraoperatively during extraventricular drain placement did not signi cantly affect the incidence of catheter-induced hemorrhage. However, the mean age of those receiving VerifyNow® Assay was signi cantly higher than the control patients (54.5 versus 38.5 years, p < 0.0001).…”

Section: Bleeding Eventsmentioning

confidence: 95%

Point of Care Platelet Function Testing for Guided Transfusion in Neurosurgical Management of Intracranial Hemorrhage: A Systematic Review

Lim

Sim

et al. 2022

Preprint

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Given the rising prevalence of antiplatelet therapy, rapid preoperative identification of patients with bleeding diathesis is necessary for the guidance of blood product administration. This is especially relevant in neurosurgery for intracranial hemorrhage (ICH), where indiscriminate transfusions may lead to further hemorrhagic or thromboembolic injury. Point-of-care (POC) testing of platelet function is a promising solution to this dilemma, as it has been proven effective in cardiac surgery. However, to date, POC platelet function testing in neurosurgery has not been extensively evaluated. This systematic review appraises the use of POC platelet function test (PFT) in emergency neurosurgery in terms of its impact on patient outcomes. A comprehensive search was conducted on four electronic databases (Pubmed, MEDLINE, Embase, and Cochrane) for relevant English language articles from their respective inceptions until 1 June 2022. We included all randomized controlled trials and cohort studies that met the following inclusion criteria: (i) involved adult patients undergoing neurosurgery for ICH; (ii) evaluated platelet function via POC PFT; (iii) reported a change in perioperative blood loss; and/or (iv) reported data on treatment-related adverse events and mortality. Assessment of study quality was conducted using the Newcastle Ottawa Quality Assessment Scale for Cohort Studies and Case-Control Studies, and the JBI Critical Appraisal Checklist for Case Series. The search yielded 2,835 studies, of which seven observational studies comprising 849 patients met the inclusion criteria for this review. Overall, there is evidence that the use of POC PFT to assess bleeding risk reduced bleeding events, thromboembolic adverse outcomes, and the length of hospitalization. However, there is currently insufficient evidence to suggest that using POC PFT improves blood product use, functional outcomes or mortality.

show abstract

Hemorrhagic Complications of External Ventriculostomy in the Aspirin and P2Y12 Response Assay Era

Cited by 10 publications

References 23 publications

Point-of-care platelet function testing for guided transfusion in neurosurgical management of intracranial hemorrhage: a systematic review

Point-of-care platelet function testing for guided transfusion in neurosurgical management of intracranial hemorrhage: a systematic review

Impact of Intravenous Aspirin Administration on Ventriculostomy-Associated Hemorrhage in Coiled Acute Subarachnoid Hemorrhage Patients

Point of Care Platelet Function Testing for Guided Transfusion in Neurosurgical Management of Intracranial Hemorrhage: A Systematic Review

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