Emergency reversal of antiplatelet agents in patients presenting with an intracranial hemorrhage: a clinical review.
Publication/Presentation Date
1-1-2010
Abstract
OBJECTIVE: Prehospital use of antiplatelet agents has been associated with an increased risk for intracranial hemorrhage (ICH) as well as a secondary increase in ICH volume after the initial hemorrhage. Strategies to reestablish platelet aggregation are used in clinical practice, but without any established guidelines or recommendations. This article serves to evaluate the literature regarding "reversal" of antiplatelet agents in neurosurgical populations.
METHODS: PubMed and MEDLINE databases were searched for publications from 1966 to 2009 relating to intracranial hemorrhage and antiplatelet agents. The reference sections of recent articles, guidelines, and reviews were reviewed and pertinent articles identified. Studies were classified by two broad subsets: those describing intracranial hemorrhage relatable to a traumatic mechanism and those with a spontaneous intracranial hemorrhage. Two independent auditors recorded and analyzed study design and the reported outcome measures.
RESULTS: For the spontaneous intracranial hemorrhage group, nine reports assessing antiplatelet effects on various outcome measures were identified. Eleven studies evaluating the use of prehospital antiplatelets before a traumatic intracranial hemorrhage were examined.
CONCLUSION: The data assessing the relationship between outcome and prehospital antiplatelet agents in the setting of ICH is conflicting in both the trauma and the stroke literature. Only one retrospective review specifically addressed outcomes after attempted reversal with platelet transfusion. Further study is needed to determine whether platelet transfusion ameliorates hematoma enlargement and/or improves outcome in the setting of acute ICH.
Volume
74
Issue
2-3
First Page
279
Last Page
285
ISSN
1878-8769
Published In/Presented At
Campbell, P. G., Sen, A., Yadla, S., Jabbour, P., & Jallo, J. (2010). Emergency reversal of antiplatelet agents in patients presenting with an intracranial hemorrhage: a clinical review. World neurosurgery, 74(2-3), 279–285. https://doi.org/10.1016/j.wneu.2010.05.030
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
21492561
Department(s)
Administration and Leadership
Document Type
Article