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  • Survey evaluating clinical equipoise around platelet transfusion after head injury and traumatic intracranial haemorrhage (ICH) in patients on antiplatelet medications

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Survey evaluating clinical equipoise around platelet transfusion after head injury and traumatic intracranial haemorrhage (ICH) in patients on antiplatelet medications
  1. Catherine Ashton1,
  2. M Laffan2,
  3. P J Hutchinson3,
  4. Fiona Lecky4,5,
  5. S Ralhan1,
  6. Jason E Smith6,7,
  7. Jonathan P Coles8,
  8. Simon Stanworth9,
  9. Nicola Curry10
  1. 1 Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2 Department of Immunology and Inflammation, Imperial College London, London, UK
  3. 3 Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
  4. 4 Health Services Research, University of Sheffield, Sheffield, UK
  5. 5 Emergency Department/TARN, Salford Royal Hospitals NHS Foundation Trust, Salford, UK
  6. 6 Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
  7. 7 Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  8. 8 Anaesthesia, University of Cambridge, Cambridge, UK
  9. 9 Transfusion, NHS Blood and Transplant Organ Donation and Transplantation Directorate, Bristol, UK
  10. 10 Haematology, University of Oxford Radcliffe Department of Medicine, Oxford, UK
  1. Correspondence to Dr Catherine Ashton, Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; catherine.ashton{at}ouh.nhs.uk

Abstract

Introduction Patients aged 60 or over account for over half of the severely injured trauma patients and a traumatic brain injury is the most common injury sustained. Many of these patients are taking antiplatelet medications but there is clinical equipoise about the role of platelet transfusion in patients with traumatic intracranial haemorrhage (ICH) taking prior antiplatelet medications.

Method A prepiloted survey was designed to explore a range of clinical issues in managing patients taking antiplatelet medications admitted with a traumatic brain injury. This was sent via email to consultants and specialty registrar members of a variety of relevant UK societies and working groups in the fields of emergency medicine, critical care, neurosurgery and haematology.

Results 193 responses were received, mostly from colleagues in emergency medicine, neurosurgery, anaesthesia and haematology. Respondents indicated that there is a lack of evidence to support the use of platelet transfusion in this patient population but also lack of evidence of harm. Results also demonstrate uncertainties as to whether platelets should be given to all or some patients and doubt regarding the value of viscoelastic testing.

Discussion Our survey demonstrates equipoise in current practice with regards to platelet transfusion in patients with a traumatic ICH who are taking antiplatelet medication. There is support for additional trials to investigate the effect of platelet transfusion in this rising population of older, high-risk patients, in order to provide a better evidence-base for guideline development.

  • trauma
  • head
  • accidental falls
  • emergency department
  • haematology
  • geriatrics

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Anonymous survey response data. Data available from first author—CA, Department of Geratology, Oxford University Hospitals.

https://doi.org/10.1136/emermed-2021-211189

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. Anonymous survey response data. Data available from first author—CA, Department of Geratology, Oxford University Hospitals.

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    Footnotes

    • Handling editor Roland C Merchant

    • Twitter @CatherineAshton

    • Contributors CA has analysed the survey responses and written the manuscript. All other authors were equally involved with the survey design, distribution and editing of manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests PJH is supported by the NIHR and the Royal College of Surgeons of England. JPC is supported by the NIHR Cambridge Biomedical Research Centre.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.