Abstract
BACKGROUND: Preinjury use of antiplatelet agents (e.g., clopidogrel and aspirin) is a risk factor for increased morbidity and mortality for patients with traumatic intracranial hemorrhage (tICH). Some investigators have recommended platelet transfusion to reverse the antiplatelet effects in tICH. This evidence-based medicine review examines the evidence regarding the impact of platelet transfusion on emergency department (ED) patients with preinjury antiplatelet use and tICH on patient-oriented outcomes. METHODS: The MEDLINE, EMBASE, Cochrane Library, and other databases were searched. Studies were selected for inclusion if they compared platelet transfusion with no-platelet transfusion in the treatment of adult ED patients with preinjury antiplatelet use and tICH and reported rates of mortality, neurocognitive function, or adverse effects. We assessed the quality of the included studies using standard criteria. RESULTS: Five retrospective, registry-based studies were identified, which enrolled 635 patients cumulatively. Based on standard criteria, three studies were of low-quality evidence, and two studies were of very low-quality evidence. One study reported higher inhospital mortality for patients with platelet transfusion (relative risk, 2.42; 95% confidence interval, 1.2-4.9); another showed a lower mortality rate for patients receiving platelet transfusion (relative risk, 0.21; 95% confidence interval, 0.05-0.95). Three studies did not show any statistical difference in comparing mortality rates between the groups. No studies reported intermediate or long-term neurocognitive outcomes or adverse events. CONCLUSION: Five retrospective registry studies with suboptimal methodologies provide inadequate evidence to support the routine use of platelet transfusion in adult ED patients with preinjury antiplatelet use and tICH.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1658-1663 |
| Number of pages | 6 |
| Journal | Journal of Trauma and Acute Care Surgery |
| Volume | 72 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 2012 |
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Keywords
- Antiplatelet use
- Systematic review
- Traumatic brain injury
- Traumatic intracranial hemorrhage
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
- Surgery
Cite this
Utility of platelet transfusion in adult patients with traumatic intracranial hemorrhage and preinjury antiplatelet use : A systematic review. / Nishijima, Daniel; Zehtabchi, Shahriar; Berrong, Jeanette; Legome, Eric.
In: Journal of Trauma and Acute Care Surgery, Vol. 72, No. 6, 06.2012, p. 1658-1663.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Utility of platelet transfusion in adult patients with traumatic intracranial hemorrhage and preinjury antiplatelet use
T2 - A systematic review
AU - Nishijima, Daniel
AU - Zehtabchi, Shahriar
AU - Berrong, Jeanette
AU - Legome, Eric
PY - 2012/6
Y1 - 2012/6
N2 - BACKGROUND: Preinjury use of antiplatelet agents (e.g., clopidogrel and aspirin) is a risk factor for increased morbidity and mortality for patients with traumatic intracranial hemorrhage (tICH). Some investigators have recommended platelet transfusion to reverse the antiplatelet effects in tICH. This evidence-based medicine review examines the evidence regarding the impact of platelet transfusion on emergency department (ED) patients with preinjury antiplatelet use and tICH on patient-oriented outcomes. METHODS: The MEDLINE, EMBASE, Cochrane Library, and other databases were searched. Studies were selected for inclusion if they compared platelet transfusion with no-platelet transfusion in the treatment of adult ED patients with preinjury antiplatelet use and tICH and reported rates of mortality, neurocognitive function, or adverse effects. We assessed the quality of the included studies using standard criteria. RESULTS: Five retrospective, registry-based studies were identified, which enrolled 635 patients cumulatively. Based on standard criteria, three studies were of low-quality evidence, and two studies were of very low-quality evidence. One study reported higher inhospital mortality for patients with platelet transfusion (relative risk, 2.42; 95% confidence interval, 1.2-4.9); another showed a lower mortality rate for patients receiving platelet transfusion (relative risk, 0.21; 95% confidence interval, 0.05-0.95). Three studies did not show any statistical difference in comparing mortality rates between the groups. No studies reported intermediate or long-term neurocognitive outcomes or adverse events. CONCLUSION: Five retrospective registry studies with suboptimal methodologies provide inadequate evidence to support the routine use of platelet transfusion in adult ED patients with preinjury antiplatelet use and tICH.
AB - BACKGROUND: Preinjury use of antiplatelet agents (e.g., clopidogrel and aspirin) is a risk factor for increased morbidity and mortality for patients with traumatic intracranial hemorrhage (tICH). Some investigators have recommended platelet transfusion to reverse the antiplatelet effects in tICH. This evidence-based medicine review examines the evidence regarding the impact of platelet transfusion on emergency department (ED) patients with preinjury antiplatelet use and tICH on patient-oriented outcomes. METHODS: The MEDLINE, EMBASE, Cochrane Library, and other databases were searched. Studies were selected for inclusion if they compared platelet transfusion with no-platelet transfusion in the treatment of adult ED patients with preinjury antiplatelet use and tICH and reported rates of mortality, neurocognitive function, or adverse effects. We assessed the quality of the included studies using standard criteria. RESULTS: Five retrospective, registry-based studies were identified, which enrolled 635 patients cumulatively. Based on standard criteria, three studies were of low-quality evidence, and two studies were of very low-quality evidence. One study reported higher inhospital mortality for patients with platelet transfusion (relative risk, 2.42; 95% confidence interval, 1.2-4.9); another showed a lower mortality rate for patients receiving platelet transfusion (relative risk, 0.21; 95% confidence interval, 0.05-0.95). Three studies did not show any statistical difference in comparing mortality rates between the groups. No studies reported intermediate or long-term neurocognitive outcomes or adverse events. CONCLUSION: Five retrospective registry studies with suboptimal methodologies provide inadequate evidence to support the routine use of platelet transfusion in adult ED patients with preinjury antiplatelet use and tICH.
KW - Antiplatelet use
KW - Systematic review
KW - Traumatic brain injury
KW - Traumatic intracranial hemorrhage
UR - http://www.scopus.com/inward/record.url?scp=84864567317&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84864567317&partnerID=8YFLogxK
U2 - 10.1097/TA.0b013e318256dfc5
DO - 10.1097/TA.0b013e318256dfc5
M3 - Article
C2 - 22695437
AN - SCOPUS:84864567317
VL - 72
SP - 1658
EP - 1663
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
SN - 2163-0755
IS - 6
ER -