Tessa A. Harland , Andrew Ku , Gregory Topp , Tarun Prabhala , Sruti Bandlamuri , Rachel Thiets , Fernando Figueroa , Samuel Ortiz , Alan Boulos , Pouya Entezami
{"title":"血小板功能测试不能预测轻度创伤性脑损伤的出血进展","authors":"Tessa A. Harland , Andrew Ku , Gregory Topp , Tarun Prabhala , Sruti Bandlamuri , Rachel Thiets , Fernando Figueroa , Samuel Ortiz , Alan Boulos , Pouya Entezami","doi":"10.1016/j.jocn.2025.111647","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111647"},"PeriodicalIF":1.8000,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Platelet function testing does not predict hemorrhage progression in mild traumatic brain injury\",\"authors\":\"Tessa A. Harland , Andrew Ku , Gregory Topp , Tarun Prabhala , Sruti Bandlamuri , Rachel Thiets , Fernando Figueroa , Samuel Ortiz , Alan Boulos , Pouya Entezami\",\"doi\":\"10.1016/j.jocn.2025.111647\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>\",\"PeriodicalId\":15487,\"journal\":{\"name\":\"Journal of Clinical Neuroscience\",\"volume\":\"142 \",\"pages\":\"Article 111647\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-09-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Neuroscience\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0967586825006204\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Neuroscience","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0967586825006204","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Platelet function testing does not predict hemorrhage progression in mild traumatic brain injury
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.
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.