Introduction: Despite a lack of clinical data, platelet transfusions and desmopressin (DDAVP) are widely used to reverse the effect of antiplatelet medications for patients with traumatic intracranial hemorrhage (tICH). The objective of this study was to elicit the opinions of academic neurosurgeons on their confidence in the effectiveness of available therapies and clinical practice guidelines for antiplatelet effects in tICH. Methods: We conducted an in-person and electronic survey of academic faculty neurosurgeons in 10 geographically diverse academic medical centers in the U.S. Questions were developed by a group of 4 clinical and methodology researchers. Survey responses are presented using descriptive statistics in aggregate. Results: We analyzed responses from 62 neurosurgeons (66% response rate). Of those, 34% never administer platelets to those on aspirin, and 18% never administer platelets to those on P2Y12 inhibitors (with the remainder always, usually, or sometimes administering platelet transfusions). Among those who administer platelets, 81% use platelet function tests sometimes or always. There was wide variation in confidence that platelet transfusion reduces hematoma expansion (mean 53 mm, SD 25 mm on 100-mm visual-analog scale VAS) and on agreement with national platelet transfusion guideline recommendations for antiplatelet-associated tICH (mean 52 mm, SD 27 mm on 100-mm VAS). Most respondents (59%) administer DDAVP at least sometimes to those on P2Y12 inhibitors, but the confidence in the effectiveness of DDAVP was lower than for platelets (mean 46 mm, SD 23 mm on 100-mm VAS). The majority (89%) acknowledged that they would be willing to enroll patients in a clinical trial of platelet transfusion with a no-platelet control arm in non-operative tICH patients. Conclusions: Academic neurosurgeons expressed significant uncertainty on the utility of platelet transfusion and DDAVP for tICH, they describe significant practice variation, and many disagree with national clinical practice guideline recommendations. These data support the importance of a future clinical trial to determine definitively the utility of platelet transfusion in these patients.
Mohr et al. (Sun,) studied this question.