Goal Directed Platelet Transfusions Correct Platelet Dysfunction and May Improve Survival in Patients with Severe Traumatic Brain Injury

BACKGROUND Platelet dysfunction, defined as adenosine diphosphate (ADP) inhibition greater than 60% on thromboelastogram (TEG), is an independent predictor of increased mortality in patients with severe traumatic brain injury (TBI). We changed our practice to transfuse platelets for all patients with severe TBI and platelet dysfunction. We hypothesized that platelet transfusions would correct platelet dysfunction and improve mortality in patients with severe TBI. METHODS This retrospective review included adult trauma patients admitted to our Level 1 trauma center from July 2015 to October 2016 with severe TBI (Head AIS ≥ 3) who presented with platelet dysfunction and subsequently received a platelet transfusion. Serial TEGs were obtained to characterize the impact of platelet transfusion on clot strength. Subsequently, the platelet transfusion group was compared to a group of historical controls with severe TBI patients and platelet dysfunction who did not receive platelet transfusion. RESULTS A total of 35 patients with severe TBI presented with platelet dysfunction. Following platelet transfusion clot strength improved as represented by decreased K time, increased α angle, maximum amplitude, and G-value, as well as correction of ADP inhibition. When comparing to 51 historic controls with severe TBI and platelet dysfunction, the 35 study patients who received a platelet transfusion had a lower mortality (9% vs. 35%; p = 0.005). In stepwise logistic regression, platelet transfusion was independently associated with decreased mortality (OR 0.23; 95% CI 0.06-0.92; p = 0.038). CONCLUSION In patients with severe TBI and platelet dysfunction, platelet transfusions correct platelet inhibition and may be associated with decreased mortality. LEVEL OF EVIDENCE IV, therapeutic Corresponding Author: Elisa J. Furay, M.D. Dell Seton Medical Center at the University of Texas Attn: General Surgery, 1500 Red River Street, Austin, Texas 78701, Phone: 512-324-8470, Fax: 512-324-8471, Email: Efuray@ascension.org There are no conflicts of interest to disclose and no funding for this study This paper will be an oral podium presentation at the 48th Annual Meeting of the Western © 2018 Lippincott Williams & Wilkins, Inc.

from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2vZm04V