title: High prevalence of pharmacologically induced platelet dysfunction in the acute setting of brain injury.
abstract: BACKGROUND
  The management of patients with traumatic brain injury (TBI), primary intracerebral hemorrhage (pICH) and primary subarachnoid hemorrhage (pSAH) remains a highly demanding challenge in critical care medicine. Antithrombotic agents are one of the most relevant risk factors for poor outcome. However, in the acute setting of brain injury, information on preexisting medication might not be available. This group of patients is insufficiently characterized regarding pharmacologically induced platelet impairment.
  
  
  METHODS
  We retrospectively analyzed consecutive patients with TBI, pICH and pSAH admitted to our department with unknown preexisting medication. The impact of acetylsalicylic acid and ADP-receptor antagonists on platelet function was tested via the Multiplate analyzer. Patients' characteristics, management and the influence of platelet impairment on outcome were evaluated.
  
  
  RESULTS
  Within 25 months 103 patients with TBI (61), pICH (32) or pSAH (10) and unknown antithrombotic medication were admitted to our department. In 54 (52.4 %) of the patients reduced platelet function was detected, mainly caused by acetylsalicylic acid. In the TBI group, 30 patients (49.2 %) were identified, while Multiplate analysis detected platelet dysfunction in 19 (59.4 %) subjects in the pICH group and 5 in the pSAH group (50 %). In multivariable analysis the pathological Multiplate result was not associated with worse outcome; however, in our cohort 47 (87 %) patients received hemostatic therapy following detection of impaired platelet function.
  
  
  CONCLUSIONS
  Our results demonstrate the high frequency of pharmacologically impaired platelet function in patients with unknown preexisting medication. Early assessment of platelet function is an important tool to allow optimized treatment in these patients.
authors.affiliation: Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Vincent
authors.initials: V
authors.lastname: Prinz
authors.affiliation: Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Finger
authors.affiliation: Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Bayerl
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Rosenthal
authors.affiliation: Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wolf
authors.affiliation: Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Liman
authors.affiliation: Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. peter.vajkoczy@charite.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Vajkoczy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000009:adverse effects*; D001792:Blood Platelets / Q000187:drug effects*; D001930:Brain Injuries / Q000097:blood*; D002543:Cerebral Hemorrhage / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D010979:Platelet Function Tests; D000067716:Point-of-Care Testing; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000097:blood*
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D001241:Aspirin
keywords: ADP receptor antagonists; Acetylsalicylic acid; Antiplatelet therapy; Intracranial hemorrhage; Platelet function; Point of care; Traumatic brain injury