Traumatic Brain Injury: Platelets Plus DDAVP Found Not To Improve Outcomes

Dennis Kim, MD Los Angeles Biomedical Research Institute (LA BioMed) Researcher    MedicalResearch.com Interview with:
Dennis Kim, MD
Los Angeles Biomedical Research Institute                                                                                                                

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Kim: More than 1.7 million people in the U.S. alone suffer a traumatic brain injury (TBI) every year, often resulting in permanent disabilities or death. Up to half of these patients will experience progression of bleeding inside or around the brain, the occurrence of which is associated with an increased risk of death.

A common treatment to prevent progression of “traumatic intracranial hemorrhage” is the transfusion of platelets, which are irregular shaped cells that cause blood to clot, and the administration of desmopressin (DDAVP), a naturally occurring hormone used to treat bleeding and a number of other medical conditions. Researchers at LA BioMed conducted a three-year retrospective study of the records of patients admitted to a Level 1 trauma center with traumatic brain injury between Jan. 1, 2010 and Dec. 31, 2012. Of the 408 patients who fit the criteria, 126 received platelet transfusions and DDAVP and 282 did not.

Overall, 37% of the patients demonstrated progression of traumatic intracranial hemorrhage within four hours of admission. We compared outcomes for patients who received platelet transfusions and DDAVP and patients who did not receive this therapy. Our comparison found no significant differences in mortality or hemorrhage progression between the two groups. We reported our findings in a study that was recently published online ahead of print in the Journal of Neurotrauma.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Kim: Previous studies of platelet transfusion have looked only at mortality, and few studies have addressed the effect of DDAVP on bleeding in patients with TBI. Our study found that the administration of platelets and DDAVP is no more effective in preventing progression of hemorrhage or death than was the use of none of these medications, irrespective of whether or not patients were on antiplatelet medications, such as aspirin, prior to their traumatic brain injury. Given the limited availability and potential for complications associated with transfusion of blood products like platelets, we believe that physicians should take a step back and re-think the perceived necessity and efficacy of such treatments in patients with traumatic brain injury.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Kim: Although much emphasis is placed on avoiding hypotension and hypoxia in patients with traumatic brain injury in order to prevent secondary brain injury, the impact of high systemic blood pressures has received little attention in patients with TBI. This is in stark contrast to patients with spontaneous intracerebral hemorrhage, in whom early lowering of blood pressure seems to reduce hematoma growth and potentially improve outcomes. When we examined risk factors for hemorrhage progression, the only variable associated with an increase in the size of the initial bleed was increased blood pressure at the time of admission to hospital. Therefore, in addition to avoiding hypotension or low blood pressure, our results suggest that we should also be paying attention to blood pressures on the higher end of normal. Future studies examining risk factors for hemorrhage progression as well as neurologic outcomes in patients with traumatic brain injury should consider elevated blood pressures as a risk factor or covariate for poor outcomes.

Our study was limited by its retrospective design. First, the decision to administer platelet and DDAVP was at the discretion of the neurosurgery or trauma attending physicians, which introduces a potentially significant source of provider bias. Therefore, it is not possible for us to define the reasons as to why certain patients received platelets and DDAVP and others did not. Although we attempted to minimize the potential for bias and confounding using a propensity score approach, in the absence of a strict institutional protocol, no definitive conclusions regarding the utility of hemostatic adjuncts on intracranial hemorrhage progression can be drawn on the basis of the present study. A multicenter prospective randomized controlled trial is required to demonstrate a potential benefit of these hemostatic adjuncts in patients with traumatic intracranial hemorrhage.

Citation:

The Effect of Platelet and Desmopressin Administration on Early Radiographic Progression of Traumatic Intracranial Hemorrhage

Dennis Kim, Michael O’Leary, Andrew Nguyen, Amy Kaji, Scott Bricker, Angela Neville, Fred Bongard, Brant Putnam, David Plurad

Journal of Neurotrauma. January 2015, ahead of print.

MedicalResearch.com Interview with:, Dennis Kim, MD, & Los Angeles Biomedical Research Institute (2015). Traumatic Brain Injury: Platelets Plus DDAVP Found Not To Improve Outcomes MedicalResearch.com