Introduction: Traumatic brain injury continues to be a leading cause of death and disability in the United States. Intracranial hemorrhage following TBI can exacerbate brain injury and worsen outcome. An increasing number of people are prescribed antiplatelet agents for underlying cardiac and neurological disease. We sought to identify if the rapid assessment of platelet inhibition could be incorporated into a level I trauma center and determine the potential reduction in platelet transfusions and health care costs.
Methods: A retrospective review of a prospective database for patients admitted with TBI. Platelet sensitivity assays were performed and results recorded. The number of patient’s with platelet inhibition and number of single donor platelet units transfused were recorded.
Results: 60 patients were admitted with TBI within 6 months, and all patients had platelet sensitivity assays performed. 30 patients were reported to be on antiplatelet agents, 24 patients showed platelet inhibition. Our non-responder rates were 20% and 60% for aspirin and clopidogrel, respectively. In total 55 units of single donor platelets were transfused to treat the presumed antiplatelet effects. 18 units of single donor platelets were transfused in non-responders. There were no adverse reactions to transfusion. The fiscal value of these 18 units was 7200 dollars.
Conclusions: Patient safety may be improved and health costs reduced by identifying those patients without platelet inhibition. This approach may reduce the risk and need for platelet transfusions.
Patient Care: By identifying patients with history of antiplatelet medication use but without platelet inhibition, the risk and need for platelet transfusion may be reduced.
Learning Objectives: 1.To assess the utility of aspirin platelet sensitivity assays on patients with history of aspirin use and traumatic ICH.
2. To assess the utility of clopidogrel platelet sensitivity assays on patients with history of clopidogrel use and traumatic ICH.
3. To assess the cost of transfusion