gms | German Medical Science

Objective: The management of patients with traumatic brain injury (TBI), nontraumatic intracerebral hemorrhage (ICH) as well as subarachnoid hemorrhage (SAH) remains a highly demanding challenge in critical care medicine. The use of antithrombotic agents and subsequent impairment of the haemostatic system is one of the most relevant risk factors for early neurological deterioration and increased mortality. Thus early identification of patients with pre-injury anti-thrombotic medication is of utmost importance for optimized treatment. However, in particular in the acute setting of brain injury no reliable information on pre-existing medication might be available. So far this group of patients is insufficiently recognized and characterized.

Method: We retrospectively analyzed patients with TBI, nontraumatic ICH and SAH admitted to our emergency room with unknown pre-existing anti-platelet medication. Impact of ASS and ADP receptor antagonists on platelet function was tested via the Multiplate^® point of care (POC) system. Patients' characteristics and management and the influence of impaired platelet function on outcome were evaluated. Parameters were Glasgow Coma Scale (GCS), discharge status and length of intensive care treatment.

Results: Within 24 months 103 patients with TBI (61), ICH (32) or SAH (10) and unknown pre-existing anti-thrombotic medication were admitted to our emergency room. In 54 (52,4%) of all patients impaired platelet function due to intake of ASS and/or ADP receptor antagonists was detected. In the TBI group 30 patients (49,2%) were identified, while in the ICH group the Multiplate^® analysis detected 19 (59,4%) and in the SAH group 5 (50%) subjects with impaired platelet function. In univariate analysis, pathological Multiplate^® was associated with low GCS (3-8) at discharge and worsening of GCS or death (p=0.04).

Conclusions: Our results demonstrate that the incidence of impaired platelet function in patients with unknown pre-existing medication appears to be highly underrecognized although impairment of the haemostatic system is one of the most important risk factors for increased morbidity and mortality in acute brain injury. Early and rapid assessment of platelet function is an important tool to allow optimized treatment in these patients. Larger prospective studies are urgently needed to further characterize and stratify the risk profile and to clarify the impact of a pre-existing antiplatelet therapy on outcome.