Abstract
Background
In patients with acute intracerebral hemorrhage (ICH), reduced platelet activity on admission predicts hemorrhage growth and poor outcomes. We tested the hypotheses that platelet transfusion improves measured platelet activity. Further, we hypothesized that earlier treatment in patients at high risk for hemorrhage growth and poor outcome would reduce follow-up hemorrhage size and poor clinical outcomes.
Methods
We prospectively identified consecutive patients with ICH who had reduced platelet activity on admission and received a platelet transfusion. We defined high-risk patients as per a previous publication, reduced platelet activity, or known anti-platelet therapy (APT) and the diagnostic CT within 12 h of symptom onset. Platelet activity was measured with the VerifyNow-ASA (Accumetrics, CA), ICH volumes on CT with computerized quantitative techniques, and functional outcomes with the modified Rankin Scale (mRS) at 3 months.
Results
Forty-five patients received a platelet transfusion with an increase in platelet activity from 472 ± 50 (consistent with an aspirin effect) to 561 ± 92 aspirin reaction units (consistent with no aspirin effect, P < 0.001). For high-risk patients, platelet transfusion within 12 h of symptom onset, as opposed to >12 h, was associated with smaller follow-up hemorrhage size (8.4 [3–17.4] vs. 13.8 [12.3–62.5] ml, P = 0.04) and increased odds of independence (mRS < 4) at 3 months (11 of 20 vs. 0 of 7, P = 0.01). There were similar results for patients with known APT.
Conclusions
In patients at high risk for hemorrhage growth and poor outcome, early platelet transfusion improved platelet activity assay results and was associated with smaller final hemorrhage size and more independence at 3 months.
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References
Brott T, Broderick J, Kathari R, Tomsick T, Sauerbeck L, Spilker J, Duldner J, Khoury J. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke. 1997;28:1–5.
Davis SM, Broderick J, Hennerici M, Brun NC, Diringer MN, Mayer SA, Begtrup K, Steiner T, Recombinant Activated Factor VII Intracerebral Hemorrhage Trial Investigators. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology. 2006;66:1175–81.
Anderson C, Huang Y, Wang J, Arima H, Neal B, Peng B, Heeley E, Skulina C, Parsons M, Kim J, Tao Q, Li Y, Jiang J, Tai L, Zhang J, Xu E, Cheng Y, Heritier S, Morgenstern L, Chalmers J. Intensive blood pressure reduction in acute cerebral haemorrhage trial (interact): a randomised pilot trial. Lancet Neurol. 2008;7:391–9.
Mayer SA, Brun NC, Broderick J, Davis S, Diringer MN, Skolnick BE, Steiner T. Efficacy and safety of recombinant activated factor vii for acute intracerebral hemorrhage. New Engl J Med. 2008;358:2127–37.
Roquer J, Rodriguez-Compello A, Gomis M, Ois A, Munteis E. Previous anti-platelet therapy is an independent predictor of 30-day mortality after spontaneous supratentorial intracerebral hemorrhage. J Neurol. 2005;252:412–6.
Saloheimo P, Ahonen M, Juvela S, Pyhtinen J, Savolainen E, Hillborm M. Regular aspirin use preceding the onset of primary intracerebral hemorrhage is an independent predictor for death. Stroke. 2006;37:129–33.
Thompson BB, Bejot Y, Caso V, Castillo J, Christensen H, Flaherty ML, Foerch C, Ghandehari K, Giroud M, Greenberg SM, Hallevi H, Hemphill JC 3rd, Heuschmann P, Juvela S, Kimura K, Myint PK, Nagakane Y, Naritomi H, Passero S, Rodriguez-Yanez MR, Roquer J, Rosand J, Rost NS, Saloheimo P, Salomaa V, Sivenius J, Sorimachi T, Togha M, Toyoda K, Turaj W, Vemmos KN, Wolfe CD, Woo D, Smith EE. Prior antiplatelet therapy and outcome following intracerebral hemorrhage: a systematic review. Neurology. 2010;75:1333–42.
Naidech AM, Jovanovic B, Liebling S, Garg RK, Bassin SL, Bendok BR, Bernstein RA, Alberts MJ, Batjer HH. Reduced platelet activity is associated with early clot growth and worse 3-month outcome after intracerebral hemorrhage. Stroke. 2009;40:2398–401.
Morgenstern LB, Hemphill JC, Tamargo RJ, Anderson C, Becker K, Broderick JP, Connolly ES, Greenberg SM, Huang JN, MacDonald RL, Messe SR, Mitchell PH, Selim M. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2010;41:2108–29.
de Gans K, de Haan RJ, Majoie CB, Koopman MM, Brand A, Dijkgraaf MG, Vermeulen M, Roos YB. Patch: platelet transfusion in cerebral haemorrhage: study protocol for a multicentre, randomised, controlled trial. BMC Neurol. 2010;10:19.
Goldstein JN, Rosand J, Schwamm LH. Warfarin reversal in anticoagulant-associated intracerebral hemorrhage. Neurocrit Care. 2008;9:277–83.
Vlaar APJ, Binnekade JM, Prins D, van Stein D, Hofstra JJ, Schultz MJ, Juffermans NP. Risk factors and outcome of transfusion-related acute lung injury in the critically ill: a nested case–control study. Crit Care Med. 2010;38:771–8.
Morrow JF, Braine HG, Kickler TS, Ness PM, Dick JD, Fuller AK. Septic reactions to platelet transfusions. JAMA. 1991;266:555–8.
Platelet transfusion therapy—consensus conference. JAMA. 1987;257:1777–80.
Sorimachi T, Fujii Y, Morita K, Tanaka R. Predictors of hematoma enlargement in patients with intracerebral hemorrhage treated with rapid administration of antifibrinolytic agents and strict blood pressure control. J Neurosurg. 2007;106:250–4.
Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, Mayberg M, Morgenstern L, Ogilvy CS, Vespa P, Zuccarello M. Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Stroke. 2007;38:2001–23.
Wilson JTL, Hareendran A, Grant M, Baird T, Schulz UGR, Muir KW, Bone I. Improving the assessment of outcomes in stroke: use of a structured interview to assign grade on the modified Rankin scale. Stroke. 2002;33:2243–6.
Banks J, Marotta C. Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke. 2007;38:1091–6.
Karon B, Wockenfus A, Scott R, Hartman S, McConnell J, Santrach P, Jaffe A. Aspirin responsiveness in healthy volunteers measured with multiple assay platforms. Clin Chem. 2008;54:1060–5.
Lordkipanidze M, Pharand C, Schampaert E, Turgeon J, Palisaitis D, Diodati J. A comparison of six major platelet function tests to determine the prevalence of aspirin resistance in patients with stable coronary artery disease. Eur Heart J. 2007;28:1702–8.
Hillbom M, Huhtakangas J. Platelet transfusion in acute intracerebral hemorrhage. Clinicaltrials.Gov number nct00699621. Available at http://www.clinicaltrials.gov/ct2/show/NCT00699621?term=platelet+transfusion+intracerebral+hemorrhage&recr=Open&rank=1. Accessed 25 July 2008.
Goldenberg NA, Jacobson L, Manco-Johnson MJ. Brief communication: duration of platelet dysfunction after a 7-day course of ibuprofen. Ann Intern Med. 2005;142:506–9.
Vespa PM. Blood pressure after intracerebral hemorrhage: lower may not be safer. Crit Care Med. 2010;38:731–2.
Schwarz S, Hafner K, Aschoff A, Schwab S. Incidence and prognostic significance of fever following intracerebral hemorrhage. Neurology. 2000;54:354–61.
Creutzfeldt CJ, Weinstein JR, Longstreth WT Jr, Becker KJ, McPharlin TO, Tirschwell DL. Prior antiplatelet therapy, platelet infusion therapy, and outcome after intracerebral hemorrhage. J Stroke Cerebrovasc Dis. 2009;18:221–8.
Zahuranec DB, Brown DL, Lisabeth LD, Gonzales NR, Longwell PJ, Smith MA, Garcia NM, Morgenstern LB. Early care limitations independently predict mortality after intracerebral hemorrhage. Neurology. 2007;68:1651–7.
Becker KJ, Baxter AB, Cohen WA, Bybee HM, Tirschwell DL, Newell DW, Winn HR, Longstreth WT Jr. Withdrawal of support in intracerebral hemorrhage may lead to self-fulfilling prophecies. Neurology. 2001;56:766–72.
Acknowledgments
Northwestern University has applied for a use patent on desmopressin for the treatment of ICH based on peer-reviewed manuscripts by AMN; it is unclear if this has any financial value. The Office of Research at Northwestern University has determined that this does not pose a financial conflict of interest.
Conflict of interest
Andrew M. Naidech has received unrelated research support from Gaymar, Inc and Astellas Pharma US, and the Northwestern Memorial Foundation.
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Naidech, A.M., Liebling, S.M., Rosenberg, N.F. et al. Early Platelet Transfusion Improves Platelet Activity and May Improve Outcomes After Intracerebral Hemorrhage. Neurocrit Care 16, 82–87 (2012). https://doi.org/10.1007/s12028-011-9619-3
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DOI: https://doi.org/10.1007/s12028-011-9619-3