Introduction: Studies suggest that platelet dysfunction may be associated with hematoma expansion and clinical outcome in patients with intracerebral hemorrhage (ICH). Clinicians routinely administer platelets to patients with ICH and documented use of antiplatelet agents. The recent stroke guidelines state that usefulness of platelet transfusions in ICH patients with a history of antiplatelet use is unclear and is considered investigational. We sought to determine the utility of platelet sensitivity assays at the time of admission to guide platelet transfusions as well as evaluate risk and cost reductions associated with platelet transfusions.
Methods: Retrospective review of a prospective database for patients admitted with ICH. Platelet sensitivity assays were performed and results recorded. Number of patient’s with inhibition and number of single donor platelet units transfused were recorded.
Results: 43 patients were admitted with nontraumatic ICH over 6 months, all patients had platelets sensitivity assays performed. 23 patients were reported to be on antiplatelet agents, 16 patients showed platelet inhibition. Our non-responder rates were 25% and 66% for aspirin and clopidogrel, respectively. 56 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 effects from transfusion. The fiscal cost of these 18 units was 7200 dollars.
Conclusions: Patient safety may be improved and health costs reduced by identifying those patients without platelet inhibition, thus reducing 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 non-traumatic ICH.
2. To assess the utility of clopidogrel platelet sensitivity assays on patients with history of clopidogrel use and non-traumatic ICH.
3. To assess the cost of transfusion