Rapid detection of platelet inhibition and dysfunction in traumatic brain injury: A prospective observational study

Alvikas, Jurgis; Zenati, Mazen S.; Campwala, Insiyah; Jansen, J. R. C.; Hassoune, Adnan; Phelos, Heather; Okonkwo, David O.; Neal, Matthew D.

doi:10.1097/ta.0000000000003427

Cited by 9 publications

(9 citation statements)

References 29 publications

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“…Consequently, the role of POC-PFTs in predicting outcome or stratifying trauma patients at a higher risk of bleeding who may subsequently benefit from platelet transfusion has not been established. Several observational studies using different POC-PFTs found conflicting results regarding the severity of trauma and prognostic information that various tests may provide [ 134 , 136 – 138 ]. In a prospective study including 221 patients with traumatic intracranial haemorrhage (TICH), patients with nonresponsive platelets had similar in-hospital mortality [3 (3.0%) vs. 6 (6.3%), p = 0.324], TICH progression [26 (27.1%) vs. 24 (26.1%), p = 0.877], intensive care unit admission rates [34 (34.3%) vs. 38 (40.0%), p = 0.415] and length of stay [3 (interquartile range, 2–8) vs. 3.2 (interquartile range, 2–7) days, p = 0.818] as those with responsive platelets [ 136 ].…”

Section: Resultsmentioning

confidence: 99%

“…Several observational studies using different POC-PFTs found conflicting results regarding the severity of trauma and prognostic information that various tests may provide [ 134 , 136 – 138 ]. In a prospective study including 221 patients with traumatic intracranial haemorrhage (TICH), patients with nonresponsive platelets had similar in-hospital mortality [3 (3.0%) vs. 6 (6.3%), p = 0.324], TICH progression [26 (27.1%) vs. 24 (26.1%), p = 0.877], intensive care unit admission rates [34 (34.3%) vs. 38 (40.0%), p = 0.415] and length of stay [3 (interquartile range, 2–8) vs. 3.2 (interquartile range, 2–7) days, p = 0.818] as those with responsive platelets [ 136 ]. In contrast, a systematic review including 16 studies on adult patients with TBI (isolated or polytrauma) indicates that TEG-PM assays are associated with mortality and bleeding complications, but points to the low quality of current evidence in this population [ 127 ].…”

Section: Resultsmentioning

confidence: 99%

“…In patients with TBI, the benefit of platelet transfusion is also controversial [ 133 , 136 ]. However, in patients with severe TBI, if ADP response improved after platelet administration, the need for neurosurgical intervention decreased, as well as mortality [ 138 ].…”

Section: Resultsmentioning

confidence: 99%

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The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

et al. 2023

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Background Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management. Methods The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma included representatives from six European professional societies and convened to assess and update the previous version of this guideline using a structured, evidence-based consensus approach. Structured literature searches covered the period since the last edition of the guideline, but considered evidence cited previously. The format of this edition has been adjusted to reflect the trend towards concise guideline documents that cite only the highest-quality studies and most relevant literature rather than attempting to provide a comprehensive literature review to accompany each recommendation. Results This guideline comprises 39 clinical practice recommendations that follow an approximate temporal path for management of the bleeding trauma patient, with recommendations grouped behind key decision points. While approximately one-third of patients who have experienced severe trauma arrive in hospital in a coagulopathic state, a systematic diagnostic and therapeutic approach has been shown to reduce the number of preventable deaths attributable to traumatic injury. Conclusion A multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice in the management of severely injured trauma patients. Further improvement in outcomes will be achieved by optimising and standardising trauma care in line with the available evidence across Europe and beyond.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

et al. 2023

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“…71,[91][92][93] Even given the limitations of available routine laboratory coagulation assays, such a protocol may be helpful to provide an initial assessment of the coagulation to screen for inherited coagulation disorders and/or potential use of anticoagulants. [94][95][96][97] Limitations of laboratory tests, particularly in severe trauma, should be considered. This includes the fact that colloids and fibrinolysis may alter prothrombin time, activated PTT, and fibrinogen assays.…”

Section: Standard and Advanced Laboratory Testsmentioning

confidence: 99%

Perioperative Considerations in Management of the Severely Bleeding Coagulopathic Patient

et al. 2023

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Inherited and acquired coagulopathy are frequently associated with major bleeding in severe trauma, cardiac surgery with cardiopulmonary bypass, and postpartum hemorrhage. Perioperative management is multifactorial and includes preoperative optimization and discontinuation of anticoagulants and antiplatelet therapy in elective procedures. Prophylactic or therapeutic use of antifibrinolytic agents is strongly recommended in guidelines and has been shown to reduce bleeding and need for allogeneic blood administration. In the context of bleeding induced by anticoagulants and/or antiplatelet therapy, reversal strategies should be considered when available. Targeted goal-directed therapy using viscoelastic point-of-care monitoring is increasingly used to guide the administration of coagulation factors and allogenic blood products. In addition, damage control surgery, which includes tamponade of large wound areas, leaving surgical fields open, and other temporary maneuvers, should be considered when bleeding is refractory to hemostatic measures.

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“…Some studies demonstrate an inability to predict mortality or hemorrhagic lesion expansion using these assays. 8 , 9 , 10 In a study of patients taking antiplatelets medications by Alvikas et al., 11 assay confirmation of platelet inhibition was not associated with poor outcomes. However, a retrospective study by Miles et al.…”

mentioning

confidence: 99%

In Reply to the Letter to the Editor Regarding “Viscoelastic Hemostatic Assays and Outcomes in Traumatic Brain Injury: A Systematic Literature Review”

Shammassian

Kelly

2022

World Neurosurgery

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Rapid detection of platelet inhibition and dysfunction in traumatic brain injury: A prospective observational study

Abstract: Supplemental digital content is available in the text.

Cited by 9 publications

References 29 publications

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

Perioperative Considerations in Management of the Severely Bleeding Coagulopathic Patient

In Reply to the Letter to the Editor Regarding “Viscoelastic Hemostatic Assays and Outcomes in Traumatic Brain Injury: A Systematic Literature Review”

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