Prior Antiplatelet Therapy, Platelet Infusion Therapy, and Outcome after Intracerebral Hemorrhage

Creutzfeldt, Claire J.; Weinstein, Jonathan R.; Longstreth, W. T.; Becker, Kyra J.; McPharlin, Thomas O.; Tirschwell, David

doi:10.1016/j.jstrokecerebrovasdis.2008.10.007

Cited by 90 publications

(65 citation statements)

References 16 publications

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“…We confirmed the results of previous studies [6,7] that demonstrated that platelet transfusion does not have a significant impact in preventing hematoma expansion, among patients taking aspirin. Of the patients that did not receive a transfusion, 29% of patients had an expansion, while 41% had an expansion following a transfusion.…”

Section: Discussionsupporting

confidence: 91%

“…The significant correlations [5,6] between aspirin use and poor outcome following ICH, probably due to hematoma expansion, suggest that minimizing hematoma growth should be a primary aim in the treatment of patients with aspirin associated ICH. Several studies reported that platelet transfusion for reversing antiplatelet therapy does not have a significant impact on the clinical outcome and does not prevent hematoma expansion [6,7]. The authors suggest that in the majority of these cases, hemorrhage expansion had already occurred before platelets were transfused.…”

Section: Introductionmentioning

confidence: 99%

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Aspirin Response Test role in platelet transfusion following intracerebral hemorrhage

Engel-Haber

Horev

Chablani

et al. 2015

Clinical Neurology and Neurosurgery

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Aspirin Response Test role in platelet transfusion following intracerebral hemorrhage

Engel-Haber

Horev

Chablani

et al. 2015

Clinical Neurology and Neurosurgery

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“…In a study of 253 patients, aspirin use prior to ICH did not increase mortality, but mortality was increased in patients who took warfarin prior to ICH [66]. Another recent study of 368 ICH patients taking aspirin demonstrated increased risk of death (OR 2.4; 95% CI, 1.1-5.6), but platelet transfusion to reverse the antiplatelet effect did not prevent death (OR 1.2; 95% CI, 0.3-5.5) [67]. Naidech et al [68] showed in a prospective study that patients admitted with ICH with reduced platelet function at the time were associated with early ICH volume growth and with worse functional outcome.…”

Section: Antiplatelet Agentsmentioning

confidence: 98%

Treatment of Coagulopathy in Intracranial Hemorrhage

Aguilar

Freeman

2010

Curr Treat Options Neurol

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Intracranial hemorrhage (ICH) complicated by coagulopathy is a medical emergency, which can delay neurosurgical intervention, lead to larger hematoma size, and increase mortality until the coagulopathy is corrected. Prompt recognition of coagulopathy during ICH is essential for correct, rapid treatment to reduce ongoing bleeding and improve survival. The proper treatment of a coagulopathic ICH patient is centered on rapid identification of the coagulopathic defect and correction of the underlying coagulopathy to stop acute bleeding. Patients with coagulopathic ICH require admission to a neuro-intensive unit care with management of airway, oxygenation, and systemic arterial and cerebral perfusion pressure; optimization of serum glucose; aggressive treatment of fever; and rehabilitation. Once the coagulopathic defect is reversed, some patients benefit from emergent neurosurgical intervention to prevent secondary brain injury from raised intracranial pressure, hydrocephalus, or mass effect. The management of ICH patients prescribed common antithrombotics such as aspirin, clopidogrel, warfarin, or heparin, as well as thrombolytic agents such as tissue plasminogen activator, is the focus of this review.

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“…However, these were retrospective studies that did not specify the interval between admission and platelet administration or the dose used. (36) The morbidity due to intracranial bleeding should be weighed against the myocardial area at risk for thrombosis. If one opts for transfusion, the dose of 10 U of platelets is suggested after 300 mg of clopidogrel or 12.5 U after a loading dose of 600 mg. (37) Platelet function can also be improved with the use of desmopressin or recombinant activated factor VII (rFVIIa).…”

Section: Treatment Of Bleeding In Nste Acsmentioning

confidence: 99%

Sangramento em síndrome coronariana aguda sem supradesnivelamento de segmento ST

Moraes¹,

Chammas²,

Neto³

et al. 2012

Rev. bras. ter. intensiva

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The development of antiplatelet and antithrombotic therapies, in addition to interventionist strategy, has resulted in great improvements in the outcomes of patients with non-ST-segment elevation acute coronary syndrome. Parallel to therapeutic advances, bleeding, which can be induced during management, increases the risk of recurrent ischemia, myocardial infarction and death. The present literature review describes the benefits and bleeding risks of each medication or intervention strategy and suggests guidelines for managing these patients. arteries) scores are prominent. The TIMI score was the first to be developed and is widely used; however, it has low sensitivity, given that hemoglobin needs to be reduced by 5 g/dL for bleeding to be considered severe. The GUSTO score has a higher sensitivity and better correlation with death and reinfarction at 30 days and at 6 months compared to TIMI.(8) The variety of scores (Table 1) has complicated comparisons between studies.With the purpose of standardizing the definitions of bleeding, North American institutions have recently created the Bleeding Academic Research Consortium (BARC).(9) This score stratifies bleeding on a scale from 0 (no bleeding) to 5 (fatal bleeding) and, as a major advantage, provides the ability to assess patients subjected to myocardial revascularization surgery (MRS).(9) Because BARC's definitions of bleeding have been achieved by consensus, it still requires validation, and new studies on ACS are encouraged to use this score together with previous scores so that such validation may be achieved in the near future.(9) For now, comparisons between studies of bleeding outcomes demand caution. BENEFITS AND RISKS OF NSTE ACS TREATMENTKnowledge of the risk-benefit ratio of the various tools used in the treatment of ACS is essential for the individualization of therapy (Table 2).Acetylsalicylic acid (ASA) was one of the first medications assessed for the treatment of NSTE ACS and was established as a proven method after demonstrating a 56% reduction in cardiovascular death.(10) The antiplatelet effect of ASA is irreversible and results from its inhibition of thromboxane A2. In the long run, smaller daily doses of 75 to 100 mg provide the same benefit as do larger doses of 200 mg and reduce the incidence of major bleeding by 1.8%, according to the CURE (Clopidogrel in Unstable angina to prevent Recurrent Events) criteria.(11) The gastrointestinal tract is the most common site of bleeding caused by ASA, and its chronic use increases absolute risk by 0.12% a year.(12) Acetylsalicylic acid increases the risk of intracranial bleeding 1.65-fold for an increase in absolute annual risk of 0.03%.(12) Given the great benefit on mortality provided by ASA in treatment and secondary prevention, the risk of bleeding hardly justifies its nonprescription. Therefore, ASA is contraindicated only in cases of known hypersensitivity, active peptic ulcers, blood dyscrasias or severe liver disease. (13) Clopidogrel, a thienopyridine, is an alternative for patient...

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Prior Antiplatelet Therapy, Platelet Infusion Therapy, and Outcome after Intracerebral Hemorrhage

Abstract: Background-Recent studies examining the effect of prior antiplatelet therapy (APT) on outcome in patients with spontaneous intracerebral hemorrhage (ICH) have shown conflicting results. The effect of platelet infusion therapy (PIT) on outcome in APT patients with ICH is unknown.

Cited by 90 publications

References 16 publications

Aspirin Response Test role in platelet transfusion following intracerebral hemorrhage

Aspirin Response Test role in platelet transfusion following intracerebral hemorrhage

Treatment of Coagulopathy in Intracranial Hemorrhage

Sangramento em síndrome coronariana aguda sem supradesnivelamento de segmento ST

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