BACKGROUND: In patients with acute intracerebral hemorrhage (ICH), reduced platelet activity on admission predicts hemorrhage growth and poor outcomes. We tested the hypotheses that platelet transfusion improves measured platelet activity. Further, we hypothesized that earlier treatment in patients at high risk for hemorrhage growth and poor outcome would reduce follow-up hemorrhage size and poor clinical outcomes. METHODS: We prospectively identified consecutive patients with ICH who had reduced platelet activity on admission and received a platelet transfusion. We defined high-risk patients as per a previous publication, reduced platelet activity, or known anti-platelet therapy (APT) and the diagnostic CT within 12 h of symptom onset. Platelet activity was measured with the VerifyNow-ASA (Accumetrics, CA), ICH volumes on CT with computerized quantitative techniques, and functional outcomes with the modified Rankin Scale (mRS) at 3 months. RESULTS: Forty-five patients received a platelet transfusion with an increase in platelet activity from 472 ± 50 (consistent with an aspirin effect) to 561 ± 92 aspirin reaction units (consistent with no aspirin effect, P < 0.001). For high-risk patients, platelet transfusion within 12 h of symptom onset, as opposed to >12 h, was associated with smaller follow-up hemorrhage size (8.4 [3-17.4] vs. 13.8 [12.3-62.5] ml, P = 0.04) and increased odds of independence (mRS < 4) at 3 months (11 of 20 vs. 0 of 7, P = 0.01). There were similar results for patients with known APT. CONCLUSIONS: In patients at high risk for hemorrhage growth and poor outcome, early platelet transfusion improved platelet activity assay results and was associated with smaller final hemorrhage size and more independence at 3 months.
BACKGROUND: In patients with acute intracerebral hemorrhage (ICH), reduced platelet activity on admission predicts hemorrhage growth and poor outcomes. We tested the hypotheses that platelet transfusion improves measured platelet activity. Further, we hypothesized that earlier treatment in patients at high risk for hemorrhage growth and poor outcome would reduce follow-up hemorrhage size and poor clinical outcomes. METHODS: We prospectively identified consecutive patients with ICH who had reduced platelet activity on admission and received a platelet transfusion. We defined high-risk patients as per a previous publication, reduced platelet activity, or known anti-platelet therapy (APT) and the diagnostic CT within 12 h of symptom onset. Platelet activity was measured with the VerifyNow-ASA (Accumetrics, CA), ICH volumes on CT with computerized quantitative techniques, and functional outcomes with the modified Rankin Scale (mRS) at 3 months. RESULTS: Forty-five patients received a platelet transfusion with an increase in platelet activity from 472 ± 50 (consistent with an aspirin effect) to 561 ± 92 aspirin reaction units (consistent with no aspirin effect, P < 0.001). For high-risk patients, platelet transfusion within 12 h of symptom onset, as opposed to >12 h, was associated with smaller follow-up hemorrhage size (8.4 [3-17.4] vs. 13.8 [12.3-62.5] ml, P = 0.04) and increased odds of independence (mRS < 4) at 3 months (11 of 20 vs. 0 of 7, P = 0.01). There were similar results for patients with known APT. CONCLUSIONS: In patients at high risk for hemorrhage growth and poor outcome, early platelet transfusion improved platelet activity assay results and was associated with smaller final hemorrhage size and more independence at 3 months.
Authors: S M Davis; J Broderick; M Hennerici; N C Brun; M N Diringer; S A Mayer; K Begtrup; T Steiner Journal: Neurology Date: 2006-04-25 Impact factor: 9.910
Authors: Lewis B Morgenstern; J Claude Hemphill; Craig Anderson; Kyra Becker; Joseph P Broderick; E Sander Connolly; Steven M Greenberg; James N Huang; R Loch MacDonald; Steven R Messé; Pamela H Mitchell; Magdy Selim; Rafael J Tamargo Journal: Stroke Date: 2010-07-22 Impact factor: 7.914
Authors: B B Thompson; Y Béjot; V Caso; J Castillo; H Christensen; M L Flaherty; C Foerch; K Ghandehari; M Giroud; S M Greenberg; H Hallevi; J C Hemphill; P Heuschmann; S Juvela; K Kimura; P K Myint; Y Nagakane; H Naritomi; S Passero; M R Rodríguez-Yáñez; J Roquer; J Rosand; N S Rost; P Saloheimo; V Salomaa; J Sivenius; T Sorimachi; M Togha; K Toyoda; W Turaj; K N Vemmos; C D A Wolfe; D Woo; E E Smith Journal: Neurology Date: 2010-09-08 Impact factor: 9.910
Authors: Marie Lordkipanidzé; Chantal Pharand; Erick Schampaert; Jacques Turgeon; Donald A Palisaitis; Jean G Diodati Journal: Eur Heart J Date: 2007-06-14 Impact factor: 29.983
Authors: Craig S Anderson; Yining Huang; Ji Guang Wang; Hisatomi Arima; Bruce Neal; Bin Peng; Emma Heeley; Christian Skulina; Mark W Parsons; Jong Sung Kim; Qing Ling Tao; Yue Chun Li; Jian Dong Jiang; Li Wen Tai; Jin Li Zhang; En Xu; Yan Cheng; Stephane Heritier; Lewis B Morgenstern; John Chalmers Journal: Lancet Neurol Date: 2008-04-07 Impact factor: 44.182
Authors: Alexander P J Vlaar; Jan M Binnekade; David Prins; Danielle van Stein; Jorrit J Hofstra; Marcus J Schultz; Nicole P Juffermans Journal: Crit Care Med Date: 2010-03 Impact factor: 7.598
Authors: Matthew B Maas; Andrew M Naidech; Minjee Kim; Ayush Batra; Edward M Manno; Farzaneh A Sorond; Shyam Prabhakaran; Eric M Liotta Journal: J Stroke Cerebrovasc Dis Date: 2018-01-05 Impact factor: 2.136
Authors: Jennifer A Frontera; John J Lewin; Alejandro A Rabinstein; Imo P Aisiku; Anne W Alexandrov; Aaron M Cook; Gregory J del Zoppo; Monisha A Kumar; Ellinor I B Peerschke; Michael F Stiefel; Jeanne S Teitelbaum; Katja E Wartenberg; Cindy L Zerfoss Journal: Neurocrit Care Date: 2016-02 Impact factor: 3.210
Authors: Andrew M Naidech; Matthew B Maas; Kimberly E Levasseur-Franklin; Eric M Liotta; James C Guth; Micheal Berman; Joshua M Rosenow; Paul F Lindholm; Bernard R Bendok; Shyam Prabhakaran; Richard A Bernstein; Hau C Kwaan Journal: Stroke Date: 2014-07-08 Impact factor: 7.914