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Adenosine diphosphate platelet dysfunction on thromboelastogram is independently associated with increased morality in traumatic brain injury

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to determine if adenosine diphosphate (ADP) platelet dysfunction on thromboelastogram (TEG) is associated with increased in-hospital mortality in patients with head trauma. The hypothesis is that ADP dysfunction is associated with increased mortality.

Methods

This retrospective review evaluated trauma patients admitted to a level 1 trauma center from February 2011 to October 2013 who received a TEG. Patients were included if the TEG was drawn within the first 24 h of admission and the head abbreviated injury score was greater than or equal to three. Patients were categorized as severe ADP dysfunction if the degree of ADP inhibition on TEG exceeded 60 %.

Results

A total of 90 patients were included (no ADP dysfunction n = 37; ADP dysfunction n = 53). Initial Glasgow Coma Scale [GCS (12 ± 4 vs. 11 ± 5; p = 0.26)] and use of pre-injury antiplatelet agents (30 vs. 28 %; p = 0.88) were similar. Patients with ADP dysfunction on TEG had a higher in-hospital mortality rate (8 vs. 32 %; p < 0.01). ADP dysfunction was independently associated with in-hospital mortality upon fixed logistic regression (OR 6.2; 95 % CI 1.2–33) while controlling for age, gender, hypotension, pre-injury antiplatelet agents, GCS and Injury Severity Score.

Conclusion

ADP dysfunction on TEG is associated with increased mortality in patients with traumatic brain injury.

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Authors and Affiliations

  1. Department of Pharmaceutical Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA

    M. J. Daley, Z. Enright & J. Nguyen

  2. College of Pharmacy, University of Texas, Austin, TX, USA

    M. J. Daley, Z. Enright & J. Nguyen

  3. Department of Trauma Services, University Medical Center Brackenridge, 601 E 15th St, Austin, TX, 78701, USA

    S. Ali, A. Clark, J. D. Aydelotte, P. G. Teixeira, T. B. Coopwood & C. V. R. Brown

  4. Dell Medical School, University of Texas, Austin, TX, USA

    J. D. Aydelotte, P. G. Teixeira, T. B. Coopwood & C. V. R. Brown

Authors
  1. M. J. Daley
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  2. Z. Enright
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  3. J. Nguyen
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  4. S. Ali
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  5. A. Clark
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  6. J. D. Aydelotte
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  7. P. G. Teixeira
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  8. T. B. Coopwood
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  9. C. V. R. Brown
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Corresponding author

Correspondence to M. J. Daley.

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Conflict of interest

Mitchell Daley, Zachary Enright, Joseph Nguyen, Sadia Ali, Adam Clark, Jayson Aydelotte, Pedro Teixeira, Thomas Coopwood, and Carlos Brown declare they have no conflicts of interest to disclose related to financial or personal relationships for the subject matter of this manuscript.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Daley, M.J., Enright, Z., Nguyen, J. et al. Adenosine diphosphate platelet dysfunction on thromboelastogram is independently associated with increased morality in traumatic brain injury. Eur J Trauma Emerg Surg 43, 105–111 (2017). https://doi.org/10.1007/s00068-016-0643-z

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  • DOI: https://doi.org/10.1007/s00068-016-0643-z

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