Does Platelet Administration Affect Mortality in Elderly Head-Injured Patients Taking Antiplatelet Medications? DOUGLAS M. DOWNEY, M.D.,* BENJAMIN MONSON, M.D.,* KARYN L. BUTLER, M.D.,† GERALD R. FORTUNA,JR., M.D.,‡ JONATHAN M. SAXE, M.D.,§ JAMES P. DOLAN, M.D.,k RONALD J. MARKERT, PH.D.,* MARY C. MCCARTHY, M.D.§ From the *Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio; the †Department of Surgery, Hartford Hospital, Hartford, Connecticut; the ‡Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, Ohio; the §Division of Trauma, Department of Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio; and the kDepartment of Surgery, Oregon Health Sciences University, Portland, Oregon A significant portion of patients sustaining traumatic brain injury (TBI) take antiplatelet medications (aspirin or clopidogrel), which have been associated with increased morbidity and mortality. In an attempt to alleviate the risk of increased bleeding, platelet transfusion has become standard practice in some institutions. This study was designed to determine if platelet trans- fusion reduces mortality in patients with TBI on antiplatelet medications. Databases from two Level I trauma centers were reviewed. Patients with TBI 50 years of age or older with docu- mented preinjury use of clopidogrel or aspirin were included in our cohort. Patients who received platelet transfusions were compared with those who did not to assess outcome differences between them. Demographics and other patient characteristics abstracted included Injury Severity Score, Glasgow Coma Scale, hospital length of stay, and warfarin use. Three hundred twenty-eight patients comprised the study group. Of these patients, 166 received platelet trans- fusion and 162 patients did not. Patients who received platelets had a mortality rate of 17.5 per cent (29 of 166), whereas those who did not receive platelets had a mortality rate of 16.7 per cent (27 of 162) (P 5 0.85). Transfusion of platelets in patients with TBI using antiplatelet therapy did not reduce mortality. T RAUMATIC BRAIN INJURY (TBI) is responsible for more than one million hospital visits, over 200,000 hospital admissions, and approximately 50,000 deaths in the United States annually. 1 With the aging of our population, reports now show that these injuries are most prevalent among persons older than 75 years of age. In this population, motor vehicle crashes and falls were the two leading causes asso- ciated with TBI-related hospitalizations. 1 Over the past decade, there has been a significant increase in the use of antiplatelet agents after percuta- neous cardiac interventions, stroke prevention, and cardiac prophylaxis. Many elderly patients taking anti- platelet agents such as aspirin and clopidogrel are at risk for intracranial bleeding after trauma. In an attempt to reduce the increased morbidity and mortality associated with TBI in patients on antiplatelet or anticoagulant medications, some centers frequently treat platelet dysfunction with platelet transfusion. A recent study showed that rapid warfarin reversal with fresh-frozen plasma leads to reduction in mortality from 48 to 10 per cent in patients with intracranial hemorrhage (P < 0.001). 2 However, the reversal of platelet dysfunction in patients with TBI on antiplatelet medications has not been fully investigated. Two studies published in the past 5 years have demonstrated a significant increase in mortality among patients with TBI taking antiplatelet agents. A retro- spective review in patients with TBI comparing aspirin, warfarin, and no anticoagulation showed sig- nificantly elevated mortality in those patients taking aspirin or warfarin. However, there was no difference in mortality between patients taking aspirin and patients taking warfarin. 3 Another retrospective study investigating patients with TBI who were taking aspirin and clopidogrel showed an increased mortality in patients taking these antiplatelet medications. 4 Address correspondence and reprint requests to Jonathan M. Saxe, M.D., Department of Surgery, Wright State University Boonshoft School of Medicine, Weber Center for Health Educa- tion, Suite 7000, Miami Valley Hospital, One Wyoming Street, Dayton, OH 45409. E-mail: jonathan.m.saxe@wright.edu. 1100