The significance of platelet count in traumatic brain injury patients on antiplatelet therapy

Bellal Joseph, Viraj Pandit, David Meyer, Lynn Butvidas, Narong Kulvatunyou, Mazhar Khalil, Andrew Tang, Bardiya Zangbar, Terence OKeeffe, Lynn Gries, Randall S. Friese, Peter Rhee

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Platelet dysfunction has been attributed to progression of initial intracranial hemorrhage (ICH) on repeat head computed tomographic (RHCT) scans in patients on prehospital antiplatelet therapy. However, there is little emphasis on the effect of platelet count and progression of ICH in patients with traumatic brain injury. The aim of this study was to determine the platelet count cutoff for progression on RHCT and neurosurgical intervention in patients on antiplatelet therapy. METHODS: We performed a prospective cohort analysis of all traumatic brain injury patients with an ICH on prehospital antiplatelet therapy. Antiplatelet therapy was defined as aspirin, clopidogrel, or a combination of both. Admission platelet count was recorded and used for analysis. Receiver operating characteristic curves were plotted to identify the optimal platelet count for progression on RHCT scan and neurosurgical intervention in patients on antiplatelet therapy. RESULTS: A total of 264 patients were enrolled. Platelet count of 135,000/μL or less (area under the curve, 0.80) and platelet count of 95,000/μL or less (area under the curve, 0.92) were the optimal threshold points for progression on RHCT scan and neurosurgical intervention, respectively. Patients with platelet count of 135,000/μL or less were 12.4 times (95% confidence interval, 7.1-18.4) more likely to have progression on RHCT scan and patients with platelet count 95,000/μL or less were 31.5 times (95% confidence interval, 19.7-96.2) more likely to require neurosurgical intervention. CONCLUSION: A platelet count of less than 135,000/μL in patients on antiplatelet therapy is predictive of both radiographic and clinical worsening. This is a clinically relevant target intended to help tailor and improve management in patients on antiplatelet therapy. LEVEL OF EVIDENCE: Therapeutic study, level III.

Original languageEnglish (US)
Pages (from-to)417-421
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume77
Issue number3
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Platelet Count
Head
Intracranial Hemorrhages
Therapeutics
clopidogrel
Area Under Curve
Traumatic Brain Injury
Confidence Intervals
ROC Curve
Aspirin
Cohort Studies
Blood Platelets

Keywords

  • Antiplatelet therapy
  • neurosurgical intervention
  • platelet count
  • platelet transfusion
  • traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Joseph, B., Pandit, V., Meyer, D., Butvidas, L., Kulvatunyou, N., Khalil, M., ... Rhee, P. (2014). The significance of platelet count in traumatic brain injury patients on antiplatelet therapy. Journal of Trauma and Acute Care Surgery, 77(3), 417-421. https://doi.org/10.1097/TA.0000000000000372

The significance of platelet count in traumatic brain injury patients on antiplatelet therapy. / Joseph, Bellal; Pandit, Viraj; Meyer, David; Butvidas, Lynn; Kulvatunyou, Narong; Khalil, Mazhar; Tang, Andrew; Zangbar, Bardiya; OKeeffe, Terence; Gries, Lynn; Friese, Randall S.; Rhee, Peter.

In: Journal of Trauma and Acute Care Surgery, Vol. 77, No. 3, 01.01.2014, p. 417-421.

Research output: Contribution to journalArticle

Joseph, B, Pandit, V, Meyer, D, Butvidas, L, Kulvatunyou, N, Khalil, M, Tang, A, Zangbar, B, OKeeffe, T, Gries, L, Friese, RS & Rhee, P 2014, 'The significance of platelet count in traumatic brain injury patients on antiplatelet therapy', Journal of Trauma and Acute Care Surgery, vol. 77, no. 3, pp. 417-421. https://doi.org/10.1097/TA.0000000000000372
Joseph, Bellal ; Pandit, Viraj ; Meyer, David ; Butvidas, Lynn ; Kulvatunyou, Narong ; Khalil, Mazhar ; Tang, Andrew ; Zangbar, Bardiya ; OKeeffe, Terence ; Gries, Lynn ; Friese, Randall S. ; Rhee, Peter. / The significance of platelet count in traumatic brain injury patients on antiplatelet therapy. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 77, No. 3. pp. 417-421.
@article{1e9c638351ee4b15b6c3418d38b32781,
title = "The significance of platelet count in traumatic brain injury patients on antiplatelet therapy",
abstract = "BACKGROUND: Platelet dysfunction has been attributed to progression of initial intracranial hemorrhage (ICH) on repeat head computed tomographic (RHCT) scans in patients on prehospital antiplatelet therapy. However, there is little emphasis on the effect of platelet count and progression of ICH in patients with traumatic brain injury. The aim of this study was to determine the platelet count cutoff for progression on RHCT and neurosurgical intervention in patients on antiplatelet therapy. METHODS: We performed a prospective cohort analysis of all traumatic brain injury patients with an ICH on prehospital antiplatelet therapy. Antiplatelet therapy was defined as aspirin, clopidogrel, or a combination of both. Admission platelet count was recorded and used for analysis. Receiver operating characteristic curves were plotted to identify the optimal platelet count for progression on RHCT scan and neurosurgical intervention in patients on antiplatelet therapy. RESULTS: A total of 264 patients were enrolled. Platelet count of 135,000/μL or less (area under the curve, 0.80) and platelet count of 95,000/μL or less (area under the curve, 0.92) were the optimal threshold points for progression on RHCT scan and neurosurgical intervention, respectively. Patients with platelet count of 135,000/μL or less were 12.4 times (95{\%} confidence interval, 7.1-18.4) more likely to have progression on RHCT scan and patients with platelet count 95,000/μL or less were 31.5 times (95{\%} confidence interval, 19.7-96.2) more likely to require neurosurgical intervention. CONCLUSION: A platelet count of less than 135,000/μL in patients on antiplatelet therapy is predictive of both radiographic and clinical worsening. This is a clinically relevant target intended to help tailor and improve management in patients on antiplatelet therapy. LEVEL OF EVIDENCE: Therapeutic study, level III.",
keywords = "Antiplatelet therapy, neurosurgical intervention, platelet count, platelet transfusion, traumatic brain injury",
author = "Bellal Joseph and Viraj Pandit and David Meyer and Lynn Butvidas and Narong Kulvatunyou and Mazhar Khalil and Andrew Tang and Bardiya Zangbar and Terence OKeeffe and Lynn Gries and Friese, {Randall S.} and Peter Rhee",
year = "2014",
month = "1",
day = "1",
doi = "10.1097/TA.0000000000000372",
language = "English (US)",
volume = "77",
pages = "417--421",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - The significance of platelet count in traumatic brain injury patients on antiplatelet therapy

AU - Joseph, Bellal

AU - Pandit, Viraj

AU - Meyer, David

AU - Butvidas, Lynn

AU - Kulvatunyou, Narong

AU - Khalil, Mazhar

AU - Tang, Andrew

AU - Zangbar, Bardiya

AU - OKeeffe, Terence

AU - Gries, Lynn

AU - Friese, Randall S.

AU - Rhee, Peter

PY - 2014/1/1

Y1 - 2014/1/1

N2 - BACKGROUND: Platelet dysfunction has been attributed to progression of initial intracranial hemorrhage (ICH) on repeat head computed tomographic (RHCT) scans in patients on prehospital antiplatelet therapy. However, there is little emphasis on the effect of platelet count and progression of ICH in patients with traumatic brain injury. The aim of this study was to determine the platelet count cutoff for progression on RHCT and neurosurgical intervention in patients on antiplatelet therapy. METHODS: We performed a prospective cohort analysis of all traumatic brain injury patients with an ICH on prehospital antiplatelet therapy. Antiplatelet therapy was defined as aspirin, clopidogrel, or a combination of both. Admission platelet count was recorded and used for analysis. Receiver operating characteristic curves were plotted to identify the optimal platelet count for progression on RHCT scan and neurosurgical intervention in patients on antiplatelet therapy. RESULTS: A total of 264 patients were enrolled. Platelet count of 135,000/μL or less (area under the curve, 0.80) and platelet count of 95,000/μL or less (area under the curve, 0.92) were the optimal threshold points for progression on RHCT scan and neurosurgical intervention, respectively. Patients with platelet count of 135,000/μL or less were 12.4 times (95% confidence interval, 7.1-18.4) more likely to have progression on RHCT scan and patients with platelet count 95,000/μL or less were 31.5 times (95% confidence interval, 19.7-96.2) more likely to require neurosurgical intervention. CONCLUSION: A platelet count of less than 135,000/μL in patients on antiplatelet therapy is predictive of both radiographic and clinical worsening. This is a clinically relevant target intended to help tailor and improve management in patients on antiplatelet therapy. LEVEL OF EVIDENCE: Therapeutic study, level III.

AB - BACKGROUND: Platelet dysfunction has been attributed to progression of initial intracranial hemorrhage (ICH) on repeat head computed tomographic (RHCT) scans in patients on prehospital antiplatelet therapy. However, there is little emphasis on the effect of platelet count and progression of ICH in patients with traumatic brain injury. The aim of this study was to determine the platelet count cutoff for progression on RHCT and neurosurgical intervention in patients on antiplatelet therapy. METHODS: We performed a prospective cohort analysis of all traumatic brain injury patients with an ICH on prehospital antiplatelet therapy. Antiplatelet therapy was defined as aspirin, clopidogrel, or a combination of both. Admission platelet count was recorded and used for analysis. Receiver operating characteristic curves were plotted to identify the optimal platelet count for progression on RHCT scan and neurosurgical intervention in patients on antiplatelet therapy. RESULTS: A total of 264 patients were enrolled. Platelet count of 135,000/μL or less (area under the curve, 0.80) and platelet count of 95,000/μL or less (area under the curve, 0.92) were the optimal threshold points for progression on RHCT scan and neurosurgical intervention, respectively. Patients with platelet count of 135,000/μL or less were 12.4 times (95% confidence interval, 7.1-18.4) more likely to have progression on RHCT scan and patients with platelet count 95,000/μL or less were 31.5 times (95% confidence interval, 19.7-96.2) more likely to require neurosurgical intervention. CONCLUSION: A platelet count of less than 135,000/μL in patients on antiplatelet therapy is predictive of both radiographic and clinical worsening. This is a clinically relevant target intended to help tailor and improve management in patients on antiplatelet therapy. LEVEL OF EVIDENCE: Therapeutic study, level III.

KW - Antiplatelet therapy

KW - neurosurgical intervention

KW - platelet count

KW - platelet transfusion

KW - traumatic brain injury

UR - http://www.scopus.com/inward/record.url?scp=84907359695&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84907359695&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000000372

DO - 10.1097/TA.0000000000000372

M3 - Article

VL - 77

SP - 417

EP - 421

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 3

ER -