Effects of platelet and plasma transfusion on outcome in traumatic brain injury patients with moderate bleeding diatheses
Journal of Neurosurgery
Year, Volume, Issue, Page(s):
2013, vol. 118, issue 3, pp 676-686
Study evaluates associations between fresh frozen plasma (FFP) and platelet transfusions with long-term functional outcome and survival in patients with traumatic brain injury (TBI) and moderate hemostatic laboratory abnormalities. Data examined included patient demographics, several initial injury severity metrics, daily laboratory values, Glasgow Outcome Score- Extended (GOSE) scores, Functional Status Examination (FSE) scores, and survival to 6 months. Correlations were evaluated between these variables and transfusion of FFP, platelets, packed red blood cells (RBCs), cryoprecipitate, recombinant factor VIIa, and albumin. Analyses showed significant correlations between poor outcome scores and FFP, platelet, or packed RBC transfusion; the volume of FFP or packed RBCs transfused also correlated with poor outcome. Several measures of initial injury and laboratory abnormalities also correlated with poor outcome. Patient age, initial Glasgow Coma Scale score, and highest recorded serum sodium were included in the ordinal regression model using backward variable selection. In the moderate coagulopathy subgroup, patients transfused with FFP were more likely to have a lower GOSE score relative to those who did not receive a transfusion. Patients with moderate coagulopathy who received FFP and packed RBCs were even more likely to have a lower GOSE score. Moderately anemic patients who received packed RBCs alone were more likely to have a worse long-term functional outcome as determined by GOSE and FSE scores. No transfusion types or combinations were noted to significantly correlate with the 6-month mortality in ordinal regression. The results suggest that although transfusion is beneficial to many patients with severe hematological abnormalities, it is not without risk, and the indications for transfusion should be carefully considered in patients with moderate hematological abnormalities.
Anglin, C; Spence, J; Warner, M; Paliotta, C; Harper, C; Moore, C; Sarode, R; Madden, C; Diaz-Arrastia, R
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