title: The Effect of Platelet and Desmopressin Administration on Early Radiographic Progression of Traumatic Intracranial Hemorrhage.
abstract: Limited data exist regarding the use of hemostatic adjuncts on the progression of traumatic intracranial hemorrhage (tICH). The objective of this study was to examine the impact of platelet transfusion and desmopressin (DDAVP) administration on hemorrhage progression following tICH. We hypothesized that platelet and DDAVP administration would not result in decreased early hemorrhagic progression. We performed a three-year retrospective analysis of a Level 1 trauma center database to identify all adult patents with blunt tICH. The primary outcome was early (≤4 hours) radiographic hemorrhagic progression. Secondary outcomes included mortality, frequency of operative interventions, and complications. Multiple logistic regression analysis was performed to identify predictors for hemorrhage progression and mortality. A propensity score analysis also was performed to minimize differences and improve comparability between patients who received platelets and DDAVP and those who did not. Of 408 patients with tICH meeting the inclusion criteria, 126 received platelets and DDAVP (P/D [+]) and 282 did not (P/D [-]). Overall, 37% of patients demonstrated early radiographic hemorrhage progression. On univariate analysis, there was no difference in the incidence of hemorrhage progression between groups (43.7% [P/D (+)] vs. 34.2% [P/D (-)]; p = 0.07). On multivariate analyses, platelet and DDAVP administration was not associated with either a decreased risk of hemorrhage progression (odds ratio [OR] = 1.40, confidence interval [CI] = 0.80-2.40; p = 0.2) or mortality (OR = 1.50, CI = 0.60-4.30; p = 0.4). The administration of platelets and DDAVP is not associated with a decreased risk for early radiographic hemorrhage progression in patients with tICH. Further prospective study of these potentially hemostatic adjuncts in patients with tICH is potentially warranted.
authors.affiliation: 1 Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center , Torrance, California.
authors.forename: Dennis Yong
authors.initials: DY
authors.lastname: Kim
authors.affiliation: 2 Department of Surgery, Harbor-UCLA Medical Center , Torrance, California.
authors.forename: Michael
authors.initials: M
authors.lastname: O'Leary
authors.affiliation: 2 Department of Surgery, Harbor-UCLA Medical Center , Torrance, California.
authors.forename: Andrew
authors.initials: A
authors.lastname: Nguyen
authors.affiliation: 3 Department of Emergency Medicine, Harbor-UCLA Medical Center , Torrance, California.
authors.forename: Amy
authors.initials: A
authors.lastname: Kaji
authors.affiliation: 1 Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center , Torrance, California.
authors.forename: Scott
authors.initials: S
authors.lastname: Bricker
authors.affiliation: 1 Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center , Torrance, California.
authors.forename: Angela
authors.initials: A
authors.lastname: Neville
authors.affiliation: 1 Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center , Torrance, California.
authors.forename: Fred
authors.initials: F
authors.lastname: Bongard
authors.affiliation: 1 Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center , Torrance, California.
authors.forename: Brant
authors.initials: B
authors.lastname: Putnam
authors.affiliation: 1 Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center , Torrance, California.
authors.forename: David
authors.initials: D
authors.lastname: Plurad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D020198:Intracranial Hemorrhage, Traumatic / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion; D057216:Propensity Score; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D003894:Deamino Arginine Vasopressin
keywords: desmopressin; intracranial hemorrhage; platelets; radiographic progression; traumatic brain injury