Platelet Transfusion: An Unnecessary Risk for Mild Traumatic Brain Injury Patients on Antiplatelet Therapy

The growing percentage of Americans on anti-platelet therapy has lead to an increased incidence of anticoagulated patients within the emergency department with minor traumatic brain injury. There has been a considerable amount of literature attempting to determine the proper management of these patients. In this retrospective chart review of 108 patients on antiplatelet therapy with isolated minor traumatic brain injury (MTBI = Glasgow Coma Scale [GCS] score ≥ 13 plus intracranial hemorrhage [ICH] found on head computed tomography [CT]) admitted to a Level 1 trauma center, the authors attempted to determine whether platelet transfusions led to improved neurological outcomes. Patients were excluded from the study if they were on other forms of anticoagulation, if their intracranial hemorrhages required immediate operative management, or if any other trauma was discovered. Platelets and other blood products were transfused at the discretion of the neurosurgeon. Of the 108 patients within the study, 44 patients (41%) were transfused platelets during their hospital stay. There were no differences in basic demographics between patients receiving platelets and patients not receiving platelets, although there was a significantly increased percentage of patients taking clopidogrel in the group who received a platelet transfusion (52% vs. 20%, p = 0.0005). There were also significant differences in the characteristics of the ICHs between patient groups, with patients receiving a platelet transfusion having higher ICH volumes (20.6 mL vs. 8.2 mL, p = 0.02) and having higher Marshall classification (a CT classification for TBI, Marshall class VI platelet group = 32% vs no-platelet group 11%, p = 0.043), but no difference in overall GCS, in Rotterdam score (a separate CT score for TBI), or in the percentage of patients with a midline shift > 5 mm. There was no difference in the primary outcome of overall neurological decline between patients who received platelets and those who did not (platelet group 0% vs. 3%, p = 0.51). There was also no significant difference in the need for subsequent surgical intervention, overall medical decline, final GCS, or in deaths.