Platelet function testing does not predict hemorrhage progression in mild traumatic brain injury

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-09-23 DOI:10.1016/j.jocn.2025.111647

Tessa A. Harland , Andrew Ku , Gregory Topp , Tarun Prabhala , Sruti Bandlamuri , Rachel Thiets , Fernando Figueroa , Samuel Ortiz , Alan Boulos , Pouya Entezami

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引用次数: 0

Abstract

Background

Antiplatelet medications are frequently assumed to increase the risk of radiographic progression following traumatic intracranial hemorrhage (ICH), influencing guidelines that recommend prolonged observation and repeat imaging. However, antiplatelet use does not uniformly result in functional platelet inhibition, and the clinical relevance of therapeutic response remains unclear.

Methods

We conducted a retrospective cohort study of adult patients with traumatic ICH and a Glasgow Coma Scale (GCS) score of 13–15 who were on antiplatelet therapy and underwent platelet function testing (VerifyNow PRU or PFA) on admission. Patients were classified as therapeutic or non-therapeutic based on test thresholds. All patients received follow-up CT imaging within 24 h. Clinical variables and outcomes, including radiographic progression, surgical intervention, and mortality, were compared between groups. A sensitivity analysis excluded patients with hematocrit <30 % or platelet count <100,000.

Results

A total of 239 patients were included: 190 in the non-therapeutic group and 49 in the therapeutic group. Radiographic progression occurred in 17.6 % of patients overall, with no significant difference between therapeutic and non-therapeutic groups (20.4 % vs. 16.8 %; p = 0.53). Surgical intervention (p = 0.57) and mortality (p = 0.38) rates were similarly low and comparable. Sensitivity analyses confirmed these findings (p = 0.81).

Conclusions

Therapeutic platelet inhibition was not associated with increased risk of radiographic or clinical worsening in patients with mild traumatic ICH. These findings challenge current assumptions regarding antiplatelet risk and suggest that platelet function testing may have limited utility in this setting. These findings support the need to reevaluate current guidelines and validate risk stratification approaches through prospective multicenter studies.

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血小板功能测试不能预测轻度创伤性脑损伤的出血进展

背景：抗血小板药物通常被认为会增加外伤性颅内出血（ICH）后影像学进展的风险，这影响了推荐延长观察和重复成像的指南。然而，抗血小板使用并不一定导致功能性血小板抑制，治疗反应的临床相关性尚不清楚。方法我们对创伤性脑出血成人患者进行回顾性队列研究，这些患者的格拉斯哥昏迷评分（GCS）评分为13-15分，接受抗血小板治疗并在入院时进行血小板功能检测（VerifyNow PRU或PFA）。根据测试阈值将患者分为治疗性或非治疗性。所有患者均在24小时内接受随访CT成像。比较两组临床变量和结果，包括影像学进展、手术干预和死亡率。敏感性分析排除了血细胞比容30%或血小板计数100,000的患者。结果共纳入239例患者：非治疗组190例，治疗组49例。总体而言，17.6%的患者出现放射学进展，治疗组和非治疗组之间无显著差异（20.4%比16.8%;p = 0.53）。手术干预率（p = 0.57）和死亡率（p = 0.38）同样低且具有可比性。敏感性分析证实了这些发现（p = 0.81）。结论治疗性血小板抑制与轻度外伤性脑出血患者影像学或临床恶化风险增加无关。这些发现挑战了目前关于抗血小板风险的假设，并表明血小板功能检测在这种情况下的效用有限。这些发现支持了重新评估当前指南和通过前瞻性多中心研究验证风险分层方法的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.