Platelet Transfusion: An Unnecessary Risk for Mild Traumatic Brain Injury Patients on Antiplatelet Therapy

Washington, Chad W.; Schuerer, Douglas J.E.; Grubb, Robert L.

doi:10.1097/ta.0b013e318220ad7e

Cited by 76 publications

(53 citation statements)

References 23 publications

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“…Similar data were reported by Downey in a retrospective study involving two level 1 Trauma Centres over a 4 years period [36]. Ivascu [37] and Fortuna [38] in two separate studies observed a non significant trend towards higher mortality in patients with traumatic brain injury treated with platelets transfusion, but patients transfused were older and presented a lower GCS and higher ISS [35]. All of these studies though, have some weakness: they are retrospective, relative small and the indication and timing for platelet transfusion were not standardized.…”

Section: Resultssupporting

confidence: 81%

“…A recent metaanalysis of six studies failed to demonstrate any clear benefit of platelet transfusions in patients with either spontaneous or traumatic intracranial haemorrhage [34]. In a retrospective analysis of a cohort of 113 patients with traumatic intracerebral haemorrhage (TICH) on antiplatelet medications, Washington [35] et al, couldn't find any statistically significant difference in outcome between patients treated with platelets and those who were not transfused. Similar data were reported by Downey in a retrospective study involving two level 1 Trauma Centres over a 4 years period [36].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Prevention and treatment of trauma induced coagulopathy (TIC). An intended protocol from the Italian trauma update research group

Agostini¹,

Rondinelli²,

Bocci³

et al. 2013

J Anesthesiol Clin Sci

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In recent years, a strong focus has been put on the need to assure early coagulation support in order to prevent and treat coagulopathy in patients with severe trauma, and to improve survival. Aggressive plasma administration with high plasma/ red blood cells ratio is increasingly used worldwide. However, plasma transfusion is associated with increased risks of multiple organ dysfunction syndrome (MODS), adult respiratory distress syndrome (ARDS) and infection, which may prolong hospital stay and the need for artificial ventilation. Moreover, in the majority of European hospitals plasma cannot be immediately available and therefore it has been reported a significant delay in coagulation support. This has lead to the proposal of using clotting factors as an alternative to plasma. However, strong evidence to define the best strategy is still missing, and the only published protocols are Institution-specific, thus depending on the local organization and the available resources. The Italian Trauma Centers Network (TUN) recently developed a treatment protocol aiming at shortening the interval before the onset of coagulation support and at reducing the use of plasma. We present this protocol-Early Coagulation Support (ECS) Protocol -and discuss its rationale. Its implications for the trauma-team workflow and hospital organization are also addressed. The ECS protocol must be considered as an integrated part of a comprehensive Damage Control Strategy. The impact of the ECS Protocol on blood products consumption, trauma mortality and morbidity as well as its financial aspects, will be strictly monitored by the TUN hospitals.

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Section: Resultssupporting

confidence: 81%

Section: Resultsmentioning

confidence: 99%

Prevention and treatment of trauma induced coagulopathy (TIC). An intended protocol from the Italian trauma update research group

Agostini¹,

Rondinelli²,

Bocci³

et al. 2013

J Anesthesiol Clin Sci

View full text Add to dashboard Cite

show abstract

“…Traumatic and other intracranial hemorrhages not requiring an operation are also a relative indication for reversal, with some authors advocating for reversal in all cases [ 5 , 17 , 24 , 25 ]. This too remains a point of debate among clinicians though, as some trauma literature opposes platelet transfusion [ 26 ]. The only approved mode of reversal when necessary is to transfuse platelets, as most of these agents are irreversible [ 27 ].…”

Section: Emergency Reversal Of Antiplatelet and Anticoagulant Agents mentioning

confidence: 99%

Surgical Hemostasis in the Era of Anticoagulation: Guidelines and Recommendations Summary

Spencer

Ackerman

Iqbal

et al. 2016

Anticoagulation and Hemostasis in Neurosurgery

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“…In cases of antiplatelet therapy, studies have shown worse outcomes in patients with traumatic brain injury [16,17]. However, the results for platelet transfusion in patients on antiplatelet therapy have been inconclusive, with some studies showing no benefit in clinical outcome [18,19], others showing an improved outcome [16], and still others showing a worsened outcome [20]. Thus, while platelet transfusion is typically considered a standard of care [21], the question of the risk to benefit ratio of platelet transfusions in these circumstances remains, particularly in situations of mild traumatic brain injury.…”

Section: Antiplatelet Therapy/platelet Dysfunctionmentioning

confidence: 99%

Transfusion in Traumatic Brain Injury

Reddy

Gopinath

Robertson

2015

Curr Treat Options Neurol

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There are three primary blood products that are often transfused in traumatic brain injury: packed red blood cells (pRBCs), platelets, and plasma. For pRBCs, hemoglobin thresholds for transfusion in anemia should be set at 7 g/dl. Higher threshold is warranted only when the patient is clinically symptomatic. For platelets, transfusion thresholds should be at least 50,000/mm(3) for patients without and 100,000/mm(3) for patients with evidence of hemorrhage. Reversal of antiplatelet therapy with platelet transfusion is advisable only in patients with active bleeding. Tests for platelet function are helpful in determining an adequate platelet transfusion in these situations. Fresh frozen plasma transfusion for correction of warfarin-induced coagulopathy is also advisable in patients with active bleeding. If available, activated factor VII can be used in refractory cases. Prothrombin concentrate complexes are also another alternative in refractory situations. Transfusion goals for patients with evidence of hemorrhage should be an international normalization ratio of 1.3 or less. Prophylactic transfusion of plasma in severe traumatic brain injury without intracranial hemorrhage has not been demonstrated to improve outcome. In all situations of product transfusion, patients should be closely observed for signs of volume overload and the development of transfusion-related acute lung injury. The benefit of product transfusion should always be weighed against the risk of a transfusion-related complication.

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Platelet Transfusion: An Unnecessary Risk for Mild Traumatic Brain Injury Patients on Antiplatelet Therapy

Cited by 76 publications

References 23 publications

Prevention and treatment of trauma induced coagulopathy (TIC). An intended protocol from the Italian trauma update research group

Prevention and treatment of trauma induced coagulopathy (TIC). An intended protocol from the Italian trauma update research group

Surgical Hemostasis in the Era of Anticoagulation: Guidelines and Recommendations Summary

Transfusion in Traumatic Brain Injury

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