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High prevalence of pharmacologically induced platelet dysfunction in the acute setting of brain injury

  • Clinical Article - Brain Injury
  • Published:
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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.

Conclusion

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.

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Acknowledgments

V.P. is a participant in the Charité Clinical Scientist Program funded by the Charité-Universitätsmedizin Berlin and the Berlin Institute of Health. All authors declare that they have no conflict of interest.

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    Authors and Affiliations

    1. Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

      Vincent Prinz, Tobias Finger, Simon Bayerl, Stefan Wolf, Thomas Liman & Peter Vajkoczy

    2. Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany

      Christoph Rosenthal

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    1. Vincent Prinz
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    2. Tobias Finger
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    3. Simon Bayerl
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    Correspondence to Peter Vajkoczy.

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    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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    Vincent Prinz and Tobias Finger contributed equally to this work.

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    Prinz, V., Finger, T., Bayerl, S. et al. High prevalence of pharmacologically induced platelet dysfunction in the acute setting of brain injury. Acta Neurochir 158, 117–123 (2016). https://doi.org/10.1007/s00701-015-2645-8

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    • DOI: https://doi.org/10.1007/s00701-015-2645-8

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