• Dennis Yong Kim, Michael O'Leary, Andrew Nguyen, Amy Kaji, Scott Bricker, Angela Neville, Fred Bongard, Brant Putnam, and David Plurad.
• 1 Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center , Torrance, California.
• J. Neurotrauma. 2015 Nov 15; 32 (22): 1815-21.

AbstractLimited data exist regarding the use of hemostatic adjuncts on the progression of traumatic intracranial hemorrhage (tICH). The objective of this study was to examine the impact of platelet transfusion and desmopressin (DDAVP) administration on hemorrhage progression following tICH. We hypothesized that platelet and DDAVP administration would not result in decreased early hemorrhagic progression. We performed a three-year retrospective analysis of a Level 1 trauma center database to identify all adult patents with blunt tICH. The primary outcome was early (≤4 hours) radiographic hemorrhagic progression. Secondary outcomes included mortality, frequency of operative interventions, and complications. Multiple logistic regression analysis was performed to identify predictors for hemorrhage progression and mortality. A propensity score analysis also was performed to minimize differences and improve comparability between patients who received platelets and DDAVP and those who did not. Of 408 patients with tICH meeting the inclusion criteria, 126 received platelets and DDAVP (P/D [+]) and 282 did not (P/D [-]). Overall, 37% of patients demonstrated early radiographic hemorrhage progression. On univariate analysis, there was no difference in the incidence of hemorrhage progression between groups (43.7% [P/D (+)] vs. 34.2% [P/D (-)]; p = 0.07). On multivariate analyses, platelet and DDAVP administration was not associated with either a decreased risk of hemorrhage progression (odds ratio [OR] = 1.40, confidence interval [CI] = 0.80-2.40; p = 0.2) or mortality (OR = 1.50, CI = 0.60-4.30; p = 0.4). The administration of platelets and DDAVP is not associated with a decreased risk for early radiographic hemorrhage progression in patients with tICH. Further prospective study of these potentially hemostatic adjuncts in patients with tICH is potentially warranted.

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