Slippery Platelet Syndromes in Subdural Hematoma
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ORIGINAL ARTICLE
Slippery Platelet Syndromes in Subdural Hematoma Paul Taylor Akins • Kern Hayden Guppy Kamran Sahrakar • Mark Wade Hawk
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Published online: 12 February 2010 Ó Springer Science+Business Media, LLC 2010
Abstract Background This study investigates platelet dysfunction in patients with subdural hematomas (SDH) using platelet function analysis (PFA). Methods PFA using the PFA-100 (Dade International Inc., Miami, FL) was performed at admission using the collagen–epinephrine and collagen–ADP assays in 58 SDH patients. Clinical and radiologic information was collected. Results Normal PFA results were present in 36 patients (62%; PFA collagen:epinephrine assay (s) 118 ave; PFA collagen:adenosine diphosphate assay (s) ave 75) and abnormal platelet function in 22 patients (38%; PFA collagen:epinephrine assay (s) 231 average; PFA collagen: adenosine diphosphate assay (s) 124 average). Compared to patients with normal PFA results, patients with abnormal PFA results were more likely to have hypertension (22 vs. 55%; P = 0.01), take clopidogrel (3 vs. 32%; P = 0.001), and use anti-platelet medications and non-steroidal antiinflammatory agents (22 vs. 59%; P = 0.004). Measurements of baseline CT for midline shift, maximum thickness, presence of blood/fluid levels in the hematoma, and presence of additional sites of intracranial bleeding did not reveal significant differences based on PFA testing. Platelet dysfunction improved after platelet transfusions (PFA collagen:epinephrine assay: baseline 270 s, CI 61 s; after transfusion 124 s, CI 50 s, P < 0.001).
P. T. Akins K. H. Guppy K. Sahrakar M. W. Hawk Department of Neurosurgery, University of California, San Francisco, CA, USA P. T. Akins (&) K. H. Guppy K. Sahrakar M. W. Hawk Department of Neurosurgery, The Kaiser Permanente Medical Group, 2025 Morse Avenue, Sacramento, CA, USA e-mail: [email protected]
Conclusion Platelet dysfunction was found in 38% of SDH patients. This finding adds to our understanding of the pathophysiology of SDH. Since platelet transfusions are indicated for platelet dysfunction accompanied by major bleeding or need for surgery, these results impact perioperative management. Keywords Coagulopathy Platelets Platelet dysfunction Platelet function assay Subdural hematoma Warfarin
Introduction Subdural hematomas (SDH) are one of the most common diseases treated by neurosurgeons. In younger patients, SDH are usually acute and occur soon after trauma. In the elderly, however, SDH often accumulate in a gradual fashion, either spontaneously or after minor trauma. Hence, in seniors, they are frequently detected in the subacute or chronic phase. The risk of SDH is increased in patients with coagulopathies such as advanced liver disease, hemodialysis, warfarin use, and alcohol dependency, and the outcomes are compromised [1]. Platelets also play a role in SDH formation, since patients with hematologic diseases that cause thrombocytopenia [2] are at risk of SDH. The high frequency of SDH in patients on hemodialysis can be
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