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Utility of platelet transfusion in adult patients with traumatic intracranial hemorrhage and preinjury antiplatelet use

2012; Lippincott Williams & Wilkins; Volume: 72; Issue: 6 Linguagem: Inglês

10.1097/ta.0b013e318256dfc5

2163-0763

Daniel K. Nishijima, Shahriar Zehtabchi, Jeanette Berrong, Eric Legome,

Traumatic Brain Injury and Neurovascular Disturbances

BACKGROUND Preinjury use of antiplatelet agents (e.g., clopidogrel and aspirin) is a risk factor for increased morbidity and mortality for patients with traumatic intracranial hemorrhage (tICH). Some investigators have recommended platelet transfusion to reverse the antiplatelet effects in tICH. This evidence-based medicine review examines the evidence regarding the impact of platelet transfusion on emergency department (ED) patients with preinjury antiplatelet use and tICH on patient-oriented outcomes. METHODS The MEDLINE, EMBASE, Cochrane Library, and other databases were searched. Studies were selected for inclusion if they compared platelet transfusion with no-platelet transfusion in the treatment of adult ED patients with preinjury antiplatelet use and tICH and reported rates of mortality, neurocognitive function, or adverse effects. We assessed the quality of the included studies using standard criteria. RESULTS Five retrospective, registry-based studies were identified, which enrolled 635 patients cumulatively. Based on standard criteria, three studies were of low-quality evidence, and two studies were of very low–quality evidence. One study reported higher in-hospital mortality for patients with platelet transfusion (relative risk, 2.42; 95% confidence interval, 1.2–4.9); another showed a lower mortality rate for patients receiving platelet transfusion (relative risk, 0.21; 95% confidence interval, 0.05–0.95). Three studies did not show any statistical difference in comparing mortality rates between the groups. No studies reported intermediate or long-term neurocognitive outcomes or adverse events. CONCLUSION Five retrospective registry studies with suboptimal methodologies provide inadequate evidence to support the routine use of platelet transfusion in adult ED patients with preinjury antiplatelet use and tICH. (J Trauma Acute Care Surg. 2012;72: 1658–1663. Copyright © 2012 by Lippincott Williams & Wilkins). LEVEL OF EVIDENCE Systematic review, level III.