EXPRESS: Prehemorrhage antiplatelet use in aneurysmal subarachnoid hemorrhage and impact on clinical outcome

Background: Literature is inconclusive regarding the association between antiplatelet agents use and outcome after aneurysmal subarachnoid hemorrhage (aSAH). Aims: To investigate the association between clinical outcome and prehemorrhage use in aSAH patients as well as the impact of thrombocyte transfusion on rebleed and clinical outcome. Methods: Data were collected from prospective databases of two European tertiary reference centers for aSAH patients. Patients were divided into “antiplatelet-user” and “non-user” according to the use of acetylsalicylic acid (ASA) prior to the hemorrhage. Primary outcome was poor clinical outcome at six months (Glasgow Outcome Scale score 1-3). Secondary outcomes were in-hospital mortality, and impact of thrombocyte transfusion. Results: One hundred and sixty-one of 1,033 patients (15.6%) were antiplatelet users. The antiplatelet users were older with higher incidence of cardiovascular risk factors. Antiplatelet use was associated with poor outcome and in-hospital mortality. After correction for age, sex, WFNS score, infarction and heart disorder, pre-hemorrhage ASA use was only associated with poor clinical outcome at six months (adjusted OR 1.80, 95% CI 1.08 to 3.02). Thrombocyte transfusion was not associated with a reduction in rebleed or poor clinical outcome. Conclusion: In this multicenter study, the prehemorrhage ASA use in aSAH patients was independently associated with poor clinical outcome at six months. Thrombocyte transfusion was not associated with the rebleed rate or poor clinical outcome at six months. Data access statement: The data that support this study are available upon reasonable request.

Thromboelastographic Follow-Up Of Prophylactic Thrombocyte Transfusion

Introduction Prophylactic thrombocyte transfusion is being used to reduce increased bleeding risk after chemotherapy treatment for leukemia or malignancy. This transfusion is frequently applied when thrombocyte count is below <10.000/uL or between 10.000 and 20.000/uL. However, it was shown that thrombocyte count alone is not enough for determining bleeding risk. Moreover, given the fact that thrombocyte transfusions have inherent risks and economic burden, new laboratory approaches such as thromboelastography can be considered to determine bleeding risk in these patients. Thromboelastography is a new alternative method to conventional coagulation tests, which gives information about hemostatic system by evaluating clot’s visco-elastic and mechanical features. The aim of our study to establish a transfusion algorithm by thromboelastographic follow-up of prophylactic thrombocyte transfusion. Methods Eighty patients who have been diagnosed as acute leukemia were randomized into 4 groups. Six units random thrombocyte was given to the first group, three units random thrombocyte was given to the second group, one unit apheresis was given to the third group, and ½ unit apheresis was given to the fourth group. Before and 15 minutes after transfusion, peripheral blood was taken and CBC and rotation thromboelastograpy (ROTEM) was performed by standard device (Pentapharm GmbH, Munich, Germany). Clotting time (CT), clot formation time (CFT), and maximum clot firmness (MCF) were evaluated by 2 methods, in-TEM and ex-TEM. Patients were followed up during study by using clinical bleeding signs based on WHO bleeding grade. Patients who used medications that can affect thrombocyte functions within the last 14 days and patients who have systemic disorders (renal, hepatic, endocrinological) or hemostatic disorders were not included in this study. Variance analysis was used in order to find out statistical differences. P<0.05 was considered statistically significant. Results When platelet counts and ROTEM results were analyzed for each parameter before platelet transfusion, there were no statistically significant differences among groups. We analyzed the differences of platelet counts and thromboelastographic parameters before and after prophylactic platelet transfusion and we didn’t see any statistically significant differences between groups. Clinical bleeding signs were not correlated with platelet count in any groups. Conclusion Six units random, three units random, complete apheresis or half apheresis prophylactic platelet transfusion does not cause any significant changes in platelet count, ROTEM parameters and clinical bleeding signs. Therefore, low dose platelet transfusion can be considered because of its lower economic burden. Moreover, further studies are needed to evaluate the potential of ROTEM as an independent factor for transfusion indication. Disclosures: No relevant conflicts of interest to declare.