title: Platelet transfusion: an unnecessary risk for mild traumatic brain injury patients on antiplatelet therapy.
abstract: BACKGROUND
  To determine whether there is a benefit to platelet transfusion in mild traumatic brain injury (MTBI) patients with intracranial hemorrhage (ICH), taking antiplatelet therapy before hospitalization.
  
  
  METHODS
  The study design retrospectively reviewed patients admitted to a Level I trauma center during a 2-year period with an isolated MTBI (Glasgow Coma Scale score ≥13, ICH seen on a head computed tomographic scan (head computed tomography [HCT]), and taking an antiplatelet agent before hospitalization. HCT's were categorized based on the Marshall Classification, Rotterdam Score, and ICH volume. Hospital records were reviewed noting neurologic, cardiac, respiratory events, and discharge Glasgow Outcome Scale.
  
  
  RESULTS
  There were 1,101 patients with TBI hospitalized during the 2-year study period. Three hundred twenty-one of these patients had an MTBI with ICH at the time of admission, and from this group, 113 were taking an antiplatelet agent. Only 4 (1.2%) of the 321 patients suffered a neurologic decline. All were gradual in nature, and none required emergent intervention. An analysis of the 113 patients taking antiplatelet agents, comparing patients who were not given a platelet transfusion with those who received a platelet transfusion, found no significant difference in the rate of HCT progression, neurologic decline, or Glasgow Outcome Scale at hospital discharge between the two groups. There was a trend, which was not significant, toward more medical declines in patients who received a platelet transfusion. A further review, analyzing all 321 patients with ICH showed receiving a transfusion of any type (i.e., platelets, fresh frozen plasma, or blood) was a strong predictor of medical decline (p < 0.0001). The odds ratio of having a medical decline after transfusion was 5.8 (95% confidence interval, 1.2-28.2).
  
  
  CONCLUSIONS
  Platelet transfusion did not improve short-term outcomes after MTBI. Further randomized controlled trials need to be done to truly assess if there is no benefit in platelet transfusion in patients taking antiplatelet agents suffering an MTBI. Because the overall outcome in MTBI patients is favorable, platelet transfusion in these patients may not be indicated.
authors.affiliation: Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA. washingtonc@wudosis.wustl.edu
authors.forename: Chad W
authors.initials: CW
authors.lastname: Washington
authors.forename: Douglas J E
authors.initials: DJ
authors.lastname: Schuerer
authors.forename: Robert L
authors.initials: RL
authors.lastname: Grubb
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D020300:Intracranial Hemorrhages / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017713:Platelet Transfusion; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors