Einat Engel-Haber1, Anat Horev2, Priyanka Chablani3, Natan M Bornstein4, Ashutosh Jadhav2, Tudor G Jovin2, Vivek Reddy2, Maxim D Hammer2. 1. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: einateng@post.tau.ac.il. 2. University of Pittsburgh Medical Center, Department of Neurology, Pittsburgh, PA, United States. 3. Ohio State University College of Medicine, Columbus, OH, United States. 4. Tel Aviv Sourasky Medical Center, Department of Neurology, Tel Aviv University, Tel Aviv, Israel.
Abstract
OBJECTIVES: Spontaneous intracerebral hemorrhage (ICH) results in high morbidity and mortality. A target for therapy might be hematoma expansion, which occurs in a significant proportion of patients, and can be exacerbated by antiplatelet medications, such as aspirin. It is not clear whether platelet transfusion neutralizes aspirin. The Aspirin Response Test (ART) is commonly ordered in this patient population, but it is not clear whether the results of this test can help select patients for transfusion of platelets. The aim of our study is to investigate whether a selected group of ICH patients, those with reduced platelet activity ("aspirin responders"), will benefit from platelet transfusion. MATERIALS AND METHODS: This retrospective study included 63 patients who were taking aspirin but no other antithrombotic medication prior to the ICH. For each patient, we measured hematoma size by head CT on admission and compared with follow-up head CT 1 day later. RESULTS: In the general cohort, 41% of transfused patients and 29% of non-transfused patients had a hematoma expansion. In the "aspirin responders" group, 46% of transfused patients and 22% of non-transfused patients had an expansion. CONCLUSIONS: Our data suggest that platelet transfusion following an ICH in "aspirin responders" does not reduce hematoma expansion rates in those patients. A larger prospective study is needed.
OBJECTIVES: Spontaneous intracerebral hemorrhage (ICH) results in high morbidity and mortality. A target for therapy might be hematoma expansion, which occurs in a significant proportion of patients, and can be exacerbated by antiplatelet medications, such as aspirin. It is not clear whether platelet transfusion neutralizes aspirin. The Aspirin Response Test (ART) is commonly ordered in this patient population, but it is not clear whether the results of this test can help select patients for transfusion of platelets. The aim of our study is to investigate whether a selected group of ICHpatients, those with reduced platelet activity ("aspirin responders"), will benefit from platelet transfusion. MATERIALS AND METHODS: This retrospective study included 63 patients who were taking aspirin but no other antithrombotic medication prior to the ICH. For each patient, we measured hematoma size by head CT on admission and compared with follow-up head CT 1 day later. RESULTS: In the general cohort, 41% of transfused patients and 29% of non-transfused patients had a hematoma expansion. In the "aspirin responders" group, 46% of transfused patients and 22% of non-transfused patients had an expansion. CONCLUSIONS: Our data suggest that platelet transfusion following an ICH in "aspirin responders" does not reduce hematoma expansion rates in those patients. A larger prospective study is needed.
Authors: Alexander P J Vlaar; Joanna C Dionne; Sanne de Bruin; Marije Wijnberge; S Jorinde Raasveld; Frank E H P van Baarle; Massimo Antonelli; Cecile Aubron; Jacques Duranteau; Nicole P Juffermans; Jens Meier; Gavin J Murphy; Riccardo Abbasciano; Marcella C A Müller; Marcus Lance; Nathan D Nielsen; Herbert Schöchl; Beverley J Hunt; Maurizio Cecconi; Simon Oczkowski Journal: Intensive Care Med Date: 2021-10-22 Impact factor: 17.440