Is There a Need for Platelet Transfusion After TBI in Patients on P2Y12 Inhibitors?

Faisal Jehan, Muhammad Zeeshan, Narong Kulvatunyou, Muhammad Khan, Terence OKeeffe, Andrew Tang, Lynn Gries, Bellal Joseph

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: A significant portion of patients sustaining traumatic brain injury (TBI) are on antiplatelet medications. The reversal of P2Y12 agents after intracranial hemorrhage (ICH) remains unclear. The aim of our study is to evaluate outcomes after TBI in patients who are on preinjury P2Y12 inhibitors and received a platelet transfusion. Methods: We analyzed our prospectively maintained TBI database from 2013 to 2016 and included all patients with isolated ICH who were on P2Y12 inhibitors (Clopidogrel, Prasugrel, Ticagrelor). Regression analysis was performed adjusting for demographics and injury parameters. Outcome measures included progression of ICH, adverse discharge disposition (skilled nursing facility), and mortality. Results: A total 243 patients with ICH on preinjury P2Y12 inhibitor met our inclusion criteria and were analyzed. Mean age was 55 ± 18 y, 58% were males and 60% were white and median injury severity score was 13 [9-18]. 73.6% received platelet transfusion after admission. The median packs of platelet transfusion were 1 [1-2] units. After controlling for confounders, patients who received platelet transfusion had a lower rate of progression (OR: 0.68, P = 0.01) and decreased rate of neurosurgical intervention (OR: 0.80, P = 0.03). Overall mortality was 12.3%. Patients on P2Y12 inhibitors who received platelet transfusion had lower odds of discharge to a skilled nursing facility (OR: 0.75, P = 0.02) and mortality (OR: 0.85, P = 0.04). Conclusions: Platelet transfusion after isolated traumatic ICH in patients on P2Y12 inhibitors is associated with improved outcomes. Platelet transfusion was associated with decreased risk of progression of ICH, neurosurgical intervention, and mortality. Further randomized studies to validate the use of platelet transfusion and define the optimal dose in patients on P2Y12 inhibitors are warranted.

Original languageEnglish (US)
Pages (from-to)224-229
Number of pages6
JournalJournal of Surgical Research
Volume236
DOIs
StatePublished - Apr 1 2019
Externally publishedYes

Fingerprint

Platelet Transfusion
Intracranial Hemorrhages
Skilled Nursing Facilities
Mortality
clopidogrel
Traumatic Intracranial Hemorrhage
Injury Severity Score
Traumatic Brain Injury
Regression Analysis
Demography
Outcome Assessment (Health Care)
Databases
Wounds and Injuries

Keywords

  • ICH
  • Platelet transfusion
  • Traumatic brain injury

ASJC Scopus subject areas

  • Surgery

Cite this

Is There a Need for Platelet Transfusion After TBI in Patients on P2Y12 Inhibitors? / Jehan, Faisal; Zeeshan, Muhammad; Kulvatunyou, Narong; Khan, Muhammad; OKeeffe, Terence; Tang, Andrew; Gries, Lynn; Joseph, Bellal.

In: Journal of Surgical Research, Vol. 236, 01.04.2019, p. 224-229.

Research output: Contribution to journalArticle

Jehan, F, Zeeshan, M, Kulvatunyou, N, Khan, M, OKeeffe, T, Tang, A, Gries, L & Joseph, B 2019, 'Is There a Need for Platelet Transfusion After TBI in Patients on P2Y12 Inhibitors?', Journal of Surgical Research, vol. 236, pp. 224-229. https://doi.org/10.1016/j.jss.2018.11.050
Jehan, Faisal ; Zeeshan, Muhammad ; Kulvatunyou, Narong ; Khan, Muhammad ; OKeeffe, Terence ; Tang, Andrew ; Gries, Lynn ; Joseph, Bellal. / Is There a Need for Platelet Transfusion After TBI in Patients on P2Y12 Inhibitors?. In: Journal of Surgical Research. 2019 ; Vol. 236. pp. 224-229.
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abstract = "Background: A significant portion of patients sustaining traumatic brain injury (TBI) are on antiplatelet medications. The reversal of P2Y12 agents after intracranial hemorrhage (ICH) remains unclear. The aim of our study is to evaluate outcomes after TBI in patients who are on preinjury P2Y12 inhibitors and received a platelet transfusion. Methods: We analyzed our prospectively maintained TBI database from 2013 to 2016 and included all patients with isolated ICH who were on P2Y12 inhibitors (Clopidogrel, Prasugrel, Ticagrelor). Regression analysis was performed adjusting for demographics and injury parameters. Outcome measures included progression of ICH, adverse discharge disposition (skilled nursing facility), and mortality. Results: A total 243 patients with ICH on preinjury P2Y12 inhibitor met our inclusion criteria and were analyzed. Mean age was 55 ± 18 y, 58{\%} were males and 60{\%} were white and median injury severity score was 13 [9-18]. 73.6{\%} received platelet transfusion after admission. The median packs of platelet transfusion were 1 [1-2] units. After controlling for confounders, patients who received platelet transfusion had a lower rate of progression (OR: 0.68, P = 0.01) and decreased rate of neurosurgical intervention (OR: 0.80, P = 0.03). Overall mortality was 12.3{\%}. Patients on P2Y12 inhibitors who received platelet transfusion had lower odds of discharge to a skilled nursing facility (OR: 0.75, P = 0.02) and mortality (OR: 0.85, P = 0.04). Conclusions: Platelet transfusion after isolated traumatic ICH in patients on P2Y12 inhibitors is associated with improved outcomes. Platelet transfusion was associated with decreased risk of progression of ICH, neurosurgical intervention, and mortality. Further randomized studies to validate the use of platelet transfusion and define the optimal dose in patients on P2Y12 inhibitors are warranted.",
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T1 - Is There a Need for Platelet Transfusion After TBI in Patients on P2Y12 Inhibitors?

AU - Jehan, Faisal

AU - Zeeshan, Muhammad

AU - Kulvatunyou, Narong

AU - Khan, Muhammad

AU - OKeeffe, Terence

AU - Tang, Andrew

AU - Gries, Lynn

AU - Joseph, Bellal

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background: A significant portion of patients sustaining traumatic brain injury (TBI) are on antiplatelet medications. The reversal of P2Y12 agents after intracranial hemorrhage (ICH) remains unclear. The aim of our study is to evaluate outcomes after TBI in patients who are on preinjury P2Y12 inhibitors and received a platelet transfusion. Methods: We analyzed our prospectively maintained TBI database from 2013 to 2016 and included all patients with isolated ICH who were on P2Y12 inhibitors (Clopidogrel, Prasugrel, Ticagrelor). Regression analysis was performed adjusting for demographics and injury parameters. Outcome measures included progression of ICH, adverse discharge disposition (skilled nursing facility), and mortality. Results: A total 243 patients with ICH on preinjury P2Y12 inhibitor met our inclusion criteria and were analyzed. Mean age was 55 ± 18 y, 58% were males and 60% were white and median injury severity score was 13 [9-18]. 73.6% received platelet transfusion after admission. The median packs of platelet transfusion were 1 [1-2] units. After controlling for confounders, patients who received platelet transfusion had a lower rate of progression (OR: 0.68, P = 0.01) and decreased rate of neurosurgical intervention (OR: 0.80, P = 0.03). Overall mortality was 12.3%. Patients on P2Y12 inhibitors who received platelet transfusion had lower odds of discharge to a skilled nursing facility (OR: 0.75, P = 0.02) and mortality (OR: 0.85, P = 0.04). Conclusions: Platelet transfusion after isolated traumatic ICH in patients on P2Y12 inhibitors is associated with improved outcomes. Platelet transfusion was associated with decreased risk of progression of ICH, neurosurgical intervention, and mortality. Further randomized studies to validate the use of platelet transfusion and define the optimal dose in patients on P2Y12 inhibitors are warranted.

AB - Background: A significant portion of patients sustaining traumatic brain injury (TBI) are on antiplatelet medications. The reversal of P2Y12 agents after intracranial hemorrhage (ICH) remains unclear. The aim of our study is to evaluate outcomes after TBI in patients who are on preinjury P2Y12 inhibitors and received a platelet transfusion. Methods: We analyzed our prospectively maintained TBI database from 2013 to 2016 and included all patients with isolated ICH who were on P2Y12 inhibitors (Clopidogrel, Prasugrel, Ticagrelor). Regression analysis was performed adjusting for demographics and injury parameters. Outcome measures included progression of ICH, adverse discharge disposition (skilled nursing facility), and mortality. Results: A total 243 patients with ICH on preinjury P2Y12 inhibitor met our inclusion criteria and were analyzed. Mean age was 55 ± 18 y, 58% were males and 60% were white and median injury severity score was 13 [9-18]. 73.6% received platelet transfusion after admission. The median packs of platelet transfusion were 1 [1-2] units. After controlling for confounders, patients who received platelet transfusion had a lower rate of progression (OR: 0.68, P = 0.01) and decreased rate of neurosurgical intervention (OR: 0.80, P = 0.03). Overall mortality was 12.3%. Patients on P2Y12 inhibitors who received platelet transfusion had lower odds of discharge to a skilled nursing facility (OR: 0.75, P = 0.02) and mortality (OR: 0.85, P = 0.04). Conclusions: Platelet transfusion after isolated traumatic ICH in patients on P2Y12 inhibitors is associated with improved outcomes. Platelet transfusion was associated with decreased risk of progression of ICH, neurosurgical intervention, and mortality. Further randomized studies to validate the use of platelet transfusion and define the optimal dose in patients on P2Y12 inhibitors are warranted.

KW - ICH

KW - Platelet transfusion

KW - Traumatic brain injury

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